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Delayed c-spine evaluation

Margot Putukian
CONTEXT: The sideline assessment of concussion is challenging, given its variable presentations, the limited sensitivity and specificity of sideline assessment tools, and how the presentation of the injury evolves over time. In addition, the diagnostic process, as well as the tools used to assess and manage concussion, continue to progress as research and what we know about concussion advance. This paper focuses on the initial assessment on the sideline by reviewing the concussion-evaluation literature, drawing from clinical experience to emphasize a standardized approach, and underscoring the importance of both familiarity with the athlete and clinical judgment...
March 2017: Journal of Athletic Training
Hiroshi Sakaida, Koji Akeda, Akihiro Sudo, Kazuhiko Takeuchi
BACKGROUND: Atlantoaxial rotatory fixation is a condition in which the first and second vertebrae of the cervical spine become interlocked in a rotated position. This condition can result in serious consequences and thus have a significant impact on patients, especially when diagnosis and treatment are delayed. Some cases of atlantoaxial rotatory fixation have been described in association with otologic surgery or plastic surgery involving the ear. We present the cases of two pediatric patients who developed atlantoaxial rotatory fixation following otologic surgery and we review the relevant literature...
2017: Patient Safety in Surgery
Brent B Pickrell, Jesse D Meaike, Karina T Cañadas, Binoy M Chandy, Edward P Buchanan
Tracheal cartilaginous sleeve (TCS) is a rare and previously unrecognized source of morbidity and mortality in patients with certain craniosynostosis syndromes. There is a paucity of reporting on this airway anomaly, and the true incidence of TCS is largely unknown. The purpose of this study was to investigate the incidence of TCS among patients with syndromic craniosynostosis at our institution. Patients with syndromic craniosynostosis who underwent direct bronchoscopy and laryngoscopy were evaluated retrospectively by pediatric otolaryngologists for the presence of TCS and associated anomalies...
January 30, 2017: Journal of Craniofacial Surgery
Veena Sheshadri, Rebecca Moga, Pirjo Manninen, Christina L Goldstein, Yoga Raja Rampersaud, Eric M Massicotte, Michael G Fehlings, Lashmi Venkatraghavan
Management of the airway may be challenging in patients undergoing occipito-cervical spine fusions (OCF). Changes in the occipito-cervical angle (dOC2A) of fusion after surgery may result in acute airway obstruction, dyspnea and/or dysphagia. Objectives of the study were to review the airway management of patients during posterior OCF, determine the incidence, nature and risk factors for postoperative airway adverse events (AEs), and to determine the relationship between airway AEs and the change in dOC2A. In this retrospective cohort of 59 patients, following extubation in the operating room (OR), there were no complications in 43 (73%) patients (Group 1)...
January 16, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Gokhan Kuyumcu, Claus S Simpfendorfer, Maja Babic, Iain H Kalfas, Lucileia Teixeira-Johnson, Carl S Winalski
BACKGROUND: Septic arthritis of the atlantoaxial facet joint is extremely rare. Contiguous spread to the median atlantoaxial joints with subsequent dens erosion can lead to atlantoaxial instability. Misleading normal inflammatory markers can result in delayed diagnosis and catastrophic consequences. CASE DESCRIPTION: A 56-year-old man presented with right-sided neck pain that had lasted for 2 days. He did not have fever or chills, and his serum C-reactive protein and erythrocyte sedimentation rate were normal...
February 2017: World Neurosurgery
Lars Uhrenholt
BACKGROUND: Bicyclists are vulnerable road users and are at risk of serious spinal injury if involved in traffic crashes. In Denmark approximately 25 bicyclists are killed each year and some 20.000 bicycle related casualties are registered in the National Patient Registry each year. In addition to these figures, a large number of casualties remain unregistered despite injury. Many of the casualties will consult chiropractors in primary practice with or without preceding evaluation in the established emergency care facilities...
2016: Chiropractic & Manual Therapies
L L Wang, J Du, X N Fu, Y B Fan, C J Wei, J Ding, D D Tan, J X Xiao, H Xiong
Objective: To analyze the clinical and magnetic resonance imaging (MRI) features of congenital muscular dystrophy (CMD) to improve the diagnostic level. Method: Clinical manifestations and thigh muscle MRI results of 8 cases of CMD diagnosed on genetic level from April 2013 to November 2015 were investigated. MRI was performed on the thigh muscles of all cases. Fatty infiltration of different muscles described in T1WI was graded to evaluate. Clinical symptoms and signs, as well as muscle MRI features were analyzed by statistical description...
October 2, 2016: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
Aditi Vian Varma, Lori McBride, Michael Marble, Ann Tilton
Congenital insensitivity to pain and anhidrosis (CIPA) is one of the hereditary autonomic and sensory neuropathies. Typically presenting in infancy, it manifests as hyperpyrexia from defects in sweating (autonomic) and self-mutilating injuries from pain insensitivity (sensory). CIPA being rare in North America, diagnosis is often missed due to variable presentation. Subsequent management of its complications is therefore delayed. We report an unusual presentation in a 2-year-old girl with preexisting diagnosis of CIPA who was evaluated for bilateral upper extremity paresis of insidious onset...
November 15, 2016: Journal of the Neurological Sciences
Periklis Makrythanasis, Michel Guipponi, Federico A Santoni, Maha Zaki, Mahmoud Y Issa, Muhammad Ansar, Hanan Hamamy, Stylianos E Antonarakis
BACKGROUND: The recent availability of whole-exome sequencing has opened new possibilities for the evaluation of individuals with genetically undiagnosed intellectual disability. RESULTS: We report two affected siblings, offspring of first-cousin parents, with intellectual disability, hypotonia, short stature, growth hormone deficiency, and delayed bone age. All members of the nuclear family were genotyped, and exome sequencing was performed in one of the affected individuals...
2016: Human Genomics
Joshua B Shatsky, Timothy B Alton, Carlo Bellabarba, Richard J Bransford
Study Design. Retrospective case report and review. Objective. Cranial cervical dislocation (CCD) is commonly a devastating injury. Delay in diagnosis has been found to lead to worse outcomes. Our purpose is to describe a rare case of occult cranial cervical dislocation (CCD) and use it to highlight key clinical and radiographic findings to ensure expedited diagnosis and proper management avoiding delays and subsequent neurologic deterioration. Method. Case report with literature review. Results. We describe a unique case of occult cranial cervical dislocation where initial imaging of the cervical spine failed to illustrate displacement of the occipital-cervical (O-C1) articulation or C1-C2 articulation...
2016: Case Reports in Orthopedics
Lisa Bush, Robert Brookshire, Breanna Roche, Amelia Johnson, Frederic Cole, Riyad Karmy-Jones, William Long, Matthew J Martin
IMPORTANCE: Current trauma guidelines dictate that the cervical spine should not be cleared in intoxicated patients, resulting in prolonged immobilization or additional imaging. Modern computed tomography (CT) technology may obviate this and allow for immediate clearance. OBJECTIVE: To analyze cervical spine clearance practices and the utility of CT scans of the cervical spine in intoxicated patients with blunt trauma. DESIGN, SETTING, AND PARTICIPANTS: We performed a prospective observational study of 1668 patients with blunt trauma aged 18 years and older who underwent cervical spine CT scans from March 2014 to March 2015 at an American College of Surgeons-verified Level I trauma center...
September 1, 2016: JAMA Surgery
Manolo Piccirilli, Chiara Liberati, Giorgio Santoro, Antonio Santoro
STUDY DESIGN: Radiographic and clinical analysis. OBJECTIVE: Review author's experience with anterior discectomy, interbody fusion, and anterior cervical plating in 33 patients with posttraumatic unilateral cervical locked facets. SUMMARY OF BACKGROUND DATA: Unilateral cervical locked facet syndrome is a relatively uncommon injury that often is misdiagnosed and therefore subject to a dangerous delay in surgery. Management of this trauma is controversial...
July 2016: Clinical Spine Surgery
Sameer H Halani, Griffin R Baum, Jonathan P Riley, Gustavo Pradilla, Daniel Refai, Gerald E Rodts, Faiz U Ahmad
OBJECTIVE Esophageal perforation is a rare but well-known complication of anterior cervical spine surgery. The authors performed a systematic review of the literature to evaluate symptomatology, direct causes, repair methods, and associated complications of esophageal injury. METHODS A PubMed search that adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines included relevant clinical studies and case reports (articles written in the English language that included humans as subjects) that reported patients who underwent anterior spinal surgery and sustained some form of esophageal perforation...
September 2016: Journal of Neurosurgery. Spine
Jonathan N Sellin, William J Steele, Lauren Simpson, Wei X Huff, Brandon C Lane, Joshua J Chern, Daniel H Fulkerson, Christina M Sayama, Andrew Jea
OBJECTIVE The Thoracolumbar Injury Classification and Severity Score (TLICS) system was developed to streamline injury assessment and guide surgical decision making. To the best of the authors' knowledge, external validation in the pediatric age group has not been undertaken prior to this report. METHODS This study evaluated the use of the TLICS in a large retrospective series of children and adolescents treated at 4 pediatric medical centers (Texas Children's Hospital, Children's Healthcare of Atlanta, Riley Children's Hospital, and Doernbecher Children's Hospital)...
August 2016: Journal of Neurosurgery. Pediatrics
Daniel D Bohl, Mary R Shen, Benjamin C Mayo, Dustin H Massel, William W Long, Krishna D Modi, Bryce A Basques, Kern Singh
STUDY DESIGN: A retrospective review of data collected prospectively by the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). OBJECTIVE: The aim of this study was to investigate the association between preoperative hypoalbuminemia, a marker for malnutrition, and complications during the 30 days following posterior lumbar fusion surgery. SUMMARY OF BACKGROUND DATA: Malnutrition is a potentially modifiable risk factor that may contribute to complications following spinal surgery...
November 1, 2016: Spine
A M McGauvran, A L Kotsenas, F E Diehn, J T Wald, C M Carr, J M Morris
BACKGROUND AND PURPOSE: Imaging findings in patients with a combination of synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) are often misinterpreted as discitis/osteomyelitis or metastases, resulting in multiple biopsies and delayed diagnosis. We have incidentally noted a semicircular morphology in vertebral body imaging in several cases of SAPHO syndrome with vertebral involvement. Our goal was to evaluate the prevalence of this distinctive morphology in these patients...
August 2016: AJNR. American Journal of Neuroradiology
S N Singh, Trilok C Bhatt, Savit Kumar, Vikas Chauhan, Anjali Pandey
Tuberculosis of cervical spine is an extremely rare entity in infants with only few case reports available in the literature. The diagnosis is often delayed due to less dramatic effects of paraplegia or quadriplegia in an infant as compared to older paediatric population. Along with clinical and laboratory investigations, imaging plays a crucial role in defining the extent of involvement, evaluation of complications, providing suitable differential diagnosis and monitoring response to treatment. Tuberculosis typically involves the discovertebral complex while involvement of isolated vertebral body or multiple vertebrae without involving the intervertebral discs is much less common...
January 2016: Journal of Clinical and Diagnostic Research: JCDR
Ho Jin Lee, Il Sup Kim, Jae Hoon Sung, Sang Won Lee, Jae Taek Hong
OBJECTIVE: The aim of this study was to evaluate the efficacy of multimodal neurophysiologic intra-operative monitoring (IOM) in a cohort of patients who underwent posterior cervical surgery. MATERIAL AND METHODS: A total 182 patients were included in this study. Multi-modal intraoperative monitoring (MIOM, somatosensory-evoked potentials: SSEP/transcranial motor-evoked potentials: TCe-MEP/spontaneous-electromyography: S-EMG) was performed in a consecutive series of 129 patients and the other 53 patients (control group) did not...
April 2016: Clinical Neurology and Neurosurgery
Vincenzo De Sanctis, Heba Elsedfy, Ashraf T Soliman, Ihab Zaki Elhakim, Alessia Pepe, Christos Kattamis, Nada A Soliman, Rania Elalaily, Mohamed El Kholy, Mohamed Yassin
INTRODUCTION: In males, acquired hypogonadotropic hypogonadism (AHH) includes all disorders that damage or alter the function of gonadotropin-releasing hormone (GnRH) neurons and/or pituitary gonadotroph cells. The clinical characteristics of AHH are androgen deficiency and lack, delay or halt of pubertal sexual maturation. AHH lead to decreased libido, impaired erectile function, and strength, a worsened sense of well-being and degraded quality of life (QOL). PATIENTS AND METHODS: We studied 11 adult men with thalassemia major (TM) aged between 26 to 54 years (mean ± SD: 34...
2016: Mediterranean Journal of Hematology and Infectious Diseases
Thomas Obermüller, Maria Wostrack, Ehab Shiban, Haiko Pape, Kathrin Harmening, Benjamin Friedrich, Sascha Prothmann, Bernhard Meyer, Florian Ringel
OBJECTIVES: Vertebral artery injury (VAI) during foraminal decompression in cervical spine surgery in the absence of repositioning or screw stabilization is rare. Without immediate recognition and treatment, it may have disastrous consequences. We aimed to describe the incidence and management of iatrogenic VAI in low-risk cervical spine surgery. MATERIALS AND METHODS: The records of all patients who underwent surgical procedures of the cervical spine between January 2007 and May 2012 were retrospectively consecutively evaluated...
November 2015: Acta Neurochirurgica
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