Spinal column injury

Acute spinal cord injury (ASCI) is common and no consensuses have been reached regarding timing of surgical decompression. This article highlights the main issues regarding surgical management of ASCI patients. The importance of timing of surgery along with physiological stability of the cord, and indications for surgery has been discussed to facilitate better understanding of the condition. The importance of the type of injury to the spinal column, besides the cord injury, is also discussed. A brief review of relevant literature has been done to try and answer the question whether early or late surgical treatment for ASCI is better than conservative management, reflecting the ethos of treatment for these problems in Robert Jones And Agnes Hunt Orthopaedic Hospital in Oswestry...

Severed CNS axons often retract or dieback away from the injury site and fail to regenerate. The precise mechanisms underlying acute axonal dieback and secondary axonal degeneration remain poorly understood. Here we investigate the role of Ca(2+) store mediated intra-axonal Ca(2+) release in acute axonal dieback and secondary axonal degeneration. To differentiate between primary (directly transected) and "bystander" axonal injury (axons spared by the initial injury but then succumb to secondary degeneration) in real-time we use our previously published highly focal laser-induced spinal cord injury (LiSCI) ex vivo model...

Spinal cord injury (SCI) often disrupts the integrity of afferent (sensory) axons projecting through the spinal cord dorsal columns to the brain. Examinations of ascending sensory tracts, therefore, are critical for monitoring the extent of SCI and recovery processes. In this review, we discuss the most common electrophysiological techniques used to assess transmission of afferent inputs to the primary motor cortex (i.e., afferent-input induced facilitation and inhibition) and the somatosensory cortex (i.e...

Dislocation is the most common, and severe, spinal cord injury (SCI) mechanism in humans, yet there are few preclinical models. While dislocation in the rat model has been shown to produce unique outcomes, like other closed column models it exhibits higher outcome variability. Refinement of the dislocation model will enhance the testing of neuroprotective strategies, further biomechanical understanding, and guide therapeutic decisions. The overall objective of this study is to improve biomechanical repeatability of a dislocation SCI model in the rat, through the following specific aims: i) design new injury clamps that pivot and self-align to the vertebrae; ii) measure intervertebral kinematics during injury using the existing and redesigned clamps; and iii) compare relative motion at the vertebrae-clamp interface to determine which clamps provide the most rigid connection...

Chronic pain after spinal cord injury (SCI) is a form of central neuropathic pain that is debilitating and often refractory to current pharmacological treatments. Neurostimulation pain therapies, such as epidural spinal cord stimulation, have only moderate success in reducing SCI pain. The pathogenesis of SCI pain may involve a state of central neuronal hyperexcitability, especially in the spinal cord dorsal horn, that develops after injury. We hypothesize that the neuronal structures near the spinal cord injury site may be an important pain generator, and intraspinal microstimulation (ISMS) may normalize dorsal horn neuronal hyperexcitability and hence alleviate SCI pain...

Neurotrophic factor (NF) and Trk signaling mechanisms underlying the promotion of motor recovery following acute spinal cord injury (SCI) in rats were investigated. Thirty-six adult Sprague-Dawley rats of both genders were randomly divided into three groups: Sham-operated, model, and NF/Trk. Each group consisted of 12 rats, with four subgroups in each group: 1, 3, 5 and 7 days. Sham-operated rats received a laminectomy without SCI, while in model group rats, SCI was induced using an improved version of the Allen's method...

STUDY DESIGN: Retrospective study. PURPOSE: To evaluate how motor, sensory, and urinary outcomes of spinal cord injury (SCI) patients were influenced in the long term. OVERVIEW OF LITERATURE: SCI is a potentially disabling and devastating neurological outcome that can occur because of spinal column fractures. Most studies have not evaluated or have failed to show the influence of different surgical approaches and other parameters on neurological recovery...

STUDY DESIGN: Broad narrative review. OBJECTIVE: To review the evolution, operative technique, outcomes, and complications associated with posterior vertebral column resection. METHODS: A literature review of posterior vertebral column resection was performed. The authors' surgical technique is outlined in detail. The authors' experience and the literature regarding vertebral column resection are discussed at length. RESULTS: Treatment of severe, rigid coronal and/or sagittal malalignment with posterior vertebral column resection results in approximately 50-70% correction depending on the type of deformity...

PURPOSE: Evaluation of cervical spine injury (CSI) in children requires rapid, yet accurate assessment of damage. Given concerns of radiation exposure, expert consensus advises that computed tomography (CT) should be used sparingly. However, CT can provide superior image resolution and detection of pathology. Herein, we evaluate if X-ray offers equal diagnostic accuracy compared to CT imaging in identifying CSI in children. METHODS: We conducted a retrospective study between October 2000 and March 2012 of pediatric patients evaluated for cervical spine injury at a level 1 trauma center...

BACKGROUND: The thoracolumbar junction from T11 to L2 is a common site of injury in which fracture and dislocations are the most prevalent ones occurring at this location. Fracture dislocation is defined as failure of all three columns of the spine with gross displacement. Considering the significant violence necessary to produce fracture dislocations, these injuries are often associated with major neural deficit, with the majority of casualties becoming paraplegic immediately. Preservation of neurological function following complete fracture dislocation is quite rare entity...

BACKGROUND: Cervical spondyloptosis is defined as the dislocation of the spinal column most often caused by trauma. Due to compression or transection of the spinal cord, severe neurological deficits are common. Here, we review the literature and report a case of traumatic C5-6 spondyloptosis that was successfully treated using an anterior-only surgical approach. METHODS: The patient presented with quadriplegia and absent sensation distal to the C5 dermatome following a rollover motor vehicle accident...

STUDY DESIGN: Anatomical Study. OBJECTIVE: Determine if shoulder depression (e.g., taping the shoulders) might result in C5 nerve traction and subsequent injury. SUMMARY OF BACKGROUND DATA: Postoperative C5 nerve palsy is a recognized entity that is still often enigmatic. Inferior shoulder depression is usually employed to assist with surgical visualization during cervical spine procedures. METHODS: In the supine position, ten adult fresh frozen human cadavers underwent dissection of the spinal cord and its adjacent dorsal, ventral roots and spinal nerves from C4 to T1...

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No abstract text is available yet for this article.

PURPOSE: In principle, MR methods that exploit magnetization transfer (MT) may be used to quantify changes in the molecular composition of tissues after injury. The ability to track such changes in injured spinal cord may allow more precise assessment of the state of neural tissues. METHODS: Z-Spectra were obtained from the cervical spinal cord before and after a unilateral dorsal column lesion in monkeys at 9.4T. The amplitudes of chemical exchange saturation transfer (CEST) and nuclear Overhauser enhancement (NOE) effects from multiple proton pools, along with nonspecific semisolid MT effects from immobile macromolecules, were quantified using a five-peak Lorenzian fitting of each Z-spectrum...

OBJECT: To assess the clinical and radiographic outcomes of posterior vertebral column resection (PVCR) without anterior support in treatment of Yang's A type severe rigid thoracic kyphoscoliosis. METHODS: The records of 27 Yang's A type severe thoracic kyphoscoliosis patients treated with PVCR without anterior support from January 2010 to September 2013 were retrospectively analyzed. Intraoperative multimodal neurophysiological monitoring (IONM) (6 modes: Somatosensory evoked potential (SSEP), Motor evoked potential (MEP), Descending neurogenic evoked potential (DNEP), Spinal cord evoked potential (SCEP), and Electromyography, both triggered and free run EMG) was conducted in all patients...

OBJECTIVE: The aim of this study was to evaluate the complications, efficacy and safety of posterior vertebral column resection (PVCR) in severe angular kyphosis (SAK) greater than 100°. METHODS: The medical records of 17 patients (mean age 17.9 (range, 9-27) years) with SAK who underwent PVCR, were reviewed. Mean follow-up period was 32.2 (range, 24-64) months. Diagnosis of the patients included congenital kyphosis in 11 patients, post-tuberculosis kyphosis in 3 patients and neurofibromatosis in 3 patients...

Gunshot wounds to the spine cause severe neurological and/or internal organs damages. Although most of publications in the literature are realized on military injuries, increased civilian arming which raises civilian gunshot injuries is a new social danger causing serious health problems. In gunshot injuries to the spine; vertebral column, spinal cord and nerve roots are damaged with direct, indirect and transient cavitation related mechanisms. In this case report, we present 24 years old male patient who had severe pain and monoparesis in left upper extremity followed by gunshot injury to the spine with clinical, radiological and postoperative follow-up findings...

OBJECTIVE The authors conducted a study to compare neurological deficit rates associated with complex adult spinal deformity (ASD) surgery when recorded in retrospective and prospective studies. Retrospective studies may underreport neurological deficits due to selection, detection, and recall biases. Prospective studies are expensive and more difficult to perform, but they likely provide more accurate estimates of new neurological deficit rates. METHODS New neurological deficits were recorded in a prospective study of complex ASD surgeries (pSR1) with a defined outcomes measure (decrement in American Spinal Injury Association lower-extremity motor score) for neurological deficits...

OBJECTIVES: To report a single-institution experience with isolated transverse process fractures (ITPFs) and provide increasing support for the development of evidence-based guidelines. Additionally, the authors evaluate the presence of concerning symptoms or red flags that may indicate additional, underlying injuries in the setting of ITPFs. METHODS: The Ronald Reagan UCLA Medical Center patient database was queried (years 2005 to 2016) using International Classification of Diseases, Ninth Revision code 805: fracture of the vertebral column without mention of spinal cord injury...