1/75. Ascending myelopathy in the early stage of spinal cord injury.A 30-year-old healthy woman was involved in a road traffic accident. She sustained a fracture dislocation of T11/12 with a complete Frankel A paraplegia below T11. She had no associated injuries. High Dose methylprednisolone was administered according to the NASCIS III protocol (48 h) together with low molecular weight heparin and gastroprotected medication. Complete transection of the spinal cord and an anterior haematoma from T11 to T12 were confirmed on X rays, CT's and MRI scans. Posterior surgical stabilisation was performed using Isola instrumentation, starting 8 h post injury. Her post surgical period was uneventful except for some episodes of low blood pressure (85/60 mmHg) from which she had no symptoms. On the 12th post operative day, while in the physiotherapy department, she complained of right scapular pain. This occurred every time she was sat up and was associated with paraesthesia of both upper limbs. Two days later she deteriorated neurologically and her level ascended initially to T8 and then to T3. MRI of the spine with and without gadolinium showed spinal cord oedema between C3 and T1. There was no evidence of haemorrhage or syringomyelia. The authors discussed this case making different hypotheses. They are mainly the following: (1) Gradually ascending ischaemia due to a vascular disorder; (2) Double spinal trauma; (3) Ischaemia related to repeated hypotensive episodes; (4) Low grade intramedullary tumour; and (5) Thrombus of the Radicularis Magna artery. The case has been recognised as being very rare and interesting. In the conclusions, the presenting author stresses the importance of adopting MRI-compatible instrumentation for the surgical stabilisation of the spine, and careful monitoring of blood pressure during the acute phase of spinal cord injury. Dr Aito agrees with Mr El Masry about the opportunity of forming a group of clinicians in order to discuss protocols to cope with this devastating complication.- - - - - - - - - - ranking = 1keywords = dislocation (Clic here for more details about this article) |
2/75. adult spinal cord injury without radiological abnormality.spinal cord injury without radiological abnormality is rare in adults. A case is described of a 61 year old man who fell 15 feet from a ladder striking his head on a wall who presented with neck pain and with motor and sensory neurological abnormalities in his limbs. Plain radiographs of the neck revealed no fractures or dislocations. Further imaging with computed tomography and magnetic resonance imaging revealed an osteophyte fracture with associated cord contusion at the C5 level. Careful neurological examination is essential in all cases of potential spinal injury.- - - - - - - - - - ranking = 1keywords = dislocation (Clic here for more details about this article) |
3/75. Traumatic T9 burst fracture in an 8-month-old infant: incomplete neurologic deficit and its recovery.STUDY DESIGN: Case report of a rare burst fracture of the ninth thoracic vertebra in an 8-month-old male infant. OBJECTIVES: To describe a rare traumatic lesion in an infant. SUMMARY OF BACKGROUND DATA: There are two reported cases of fracture-dislocation in an infant in the literature, both of which were managed surgically. However, this is the first reported clinical case of burst fracture in an infant. methods: The patient was treated conservatively and observed for 40 months. His spine was examined by using roentgenography and magnetic resonance imaging. His neurologic condition was evaluated by clinical examination and somatosensory-evoked potential (SEP). RESULTS: The infant became ambulant with no need for support 2 years after injury. At that time, the burst vertebra was remodeling gradually and showed no spinal deformity. CONCLUSION: Fracture-dislocation of the spine with neurologic deficit requires surgical management. However, burst fracture can be managed conservatively, provided the neurologic condition improves.- - - - - - - - - - ranking = 2keywords = dislocation (Clic here for more details about this article) |
4/75. Obstetric dislocation of the thoracic spine: case report and review of the literature.A fracture dislocation of the upper thoracic spine with spinal cord injury is reported in a neonate. This rare injury is associated with attendant predisposing obstetric circumstances (breech transverse presentations, large baby size) that can alert clinicians of potential problems and aid in the diagnosis of neonatal hypotonia and paralysis.- - - - - - - - - - ranking = 5keywords = dislocation (Clic here for more details about this article) |
5/75. Combined anterior and posterior instrumentation in severe fracture-dislocation of the lower cervical spine with help of navigation: a case report.The authors report a case of severe fracture-dislocation of C6-C7 with dural and spinal cord damage causing quadriplegia. The patient was treated surgically with circumferential stabilisation. Intense spinal instrumentation with pedicle screw fixation in addition to anterior decompression and plate fixation was essential for restoring the original vertebral column. This technique of internal fixation provided a more rigid anchor, however the risk to the neurovascular structures could not be completely eliminated. Therefore, the combined anterior and posterior stabilisation assisted with a navigation system was a safer and reasonable surgical treatment for this patient with severe cervical injuries.- - - - - - - - - - ranking = 5keywords = dislocation (Clic here for more details about this article) |
6/75. Simultaneous noncontiguous cervical spine injuries in a pediatric patient: case report.OBJECTIVE AND IMPORTANCE: Noncontiguous traumatic injuries of the cervical spine in children are rare. We present the case of a child who simultaneously sustained a separation of the odontoid synchondrosis and a C6-C7 dislocation with a complete spinal cord injury. The management of simultaneous cervical spine injuries is discussed. CLINICAL PRESENTATION: A boy aged 4 years and 2 months was a restrained back-seat passenger involved in a head-on motor vehicle accident. The patient lacked neurological function below C7. Imaging studies revealed a separation of the odontoid synchondrosis as well as a traumatic dislocation of the spine at C6-C7. INTERVENTION: The patient was placed in a halo vest shortly after admission. Four days after his injury, he underwent a posterior wiring and fusion of C6 to C7. As the C6-C7 dislocation was reduced by posterior element wiring, intraoperative x-rays showed a gradual increase in the subluxation of C1 on C2. This increase in C1-C2 subluxation required intraoperative repositioning of the halo crown on the ventral halo vest posts to maintain acceptable C1-C2 alignment. Postoperatively, ideal alignment of the odontoid peg on the body of C2 could not be achieved by halo adjustments alone. The patient required a custom-made posterior neck cushion attached to the halo vest to maintain cervical lordosis and good alignment of the odontoid peg on the body of C2. CONCLUSION: Simultaneous traumatic cervical spine injuries in pediatric patients are rare. The intraoperative reduction of one spine injury can affect the alignment at the location of the second injury. In this case, a custom adjustment of the halo vest improved the alignment of the odontoid peg on the body of C2.- - - - - - - - - - ranking = 3keywords = dislocation (Clic here for more details about this article) |
7/75. The role of acute decompression and restoration of spinal alignment in the prevention of post-traumatic syringomyelia: case report and review of recent literature.STUDY DESIGN: Case report. INTRODUCTION: Acute post-traumatic syringomyelia formation after spinal cord injury has been considered a rare complication. At this writing, most recent reports have surfaced in neurosurgical journals. As an entity, post-traumatic syringomyelia has not been widely appreciated. It has been confused with conditions such as Hansen's disease or ulnar nerve compression at the cubital tunnel. One study also demonstrated that the occurrence of syrinx is significantly correlated with spinal stenosis after treatment, and that an inadequate reduction of the spine may lead to the formation of syrinx. This reported case describes a patient in whom post-traumatic syringomyelia began to develop 3 weeks after injury, which improved neurologically after adequate decompression. SUMMARY OF BACKGROUND DATA: A 30-year-old man sustained a 20-foot fall at work. He presented with a complete spinal cord injury below T4 secondary to a T4 fracture dislocation. The patient underwent open reduction and internal fixation of T1-T8. After 3 weeks, the patient was noted to have ascending weakness in his bilateral upper extremities and some clawing of both hands. methods: A computed tomography myelogram demonstrated inability of contrast to pass through the T4-T5 region from a lumbar puncture. An incomplete reduction was noted. The canal showed significant stenosis. A magnetic resonance image of the patient's C-spine showed increased signal in the substance of the cord extending into the C1-C2 area. The patient returned to the operating room for T3-T5 decompressive laminectomy and posterolateral decompression including the pedicles, disc, and posterior aspect of the body. Intraoperative ultrasound monitoring showed a good flow of cerebrospinal fluid past the injured segment. RESULTS: On postoperative day 1, the clawing posture of the patient's hands was significantly diminished, and the patient noted an immediate improvement in his hand and arm strength. Over the next few days, the patient's strength in the bilateral upper extremities increased to motor Grade 4/5 on manual testing. A magnetic resonance image 4 weeks after decompression showed significant improvement in the cord diameter and signal. CONCLUSIONS: Post-traumatic syringomyelia has not been reported at so early a stage after injury. This disorder is an important clinical entity that must be recognized to prevent potentially fatal or devastating complications. As evidenced by the reported patient and the literature, if this disorder is discovered and treated early, permanent deficit can be avoided. The prevention of post-traumatic syringomyelia requires anatomic realignment and stabilization of the spine without stenosis, even in the case of complete injuries, to maintain the proper dynamics of cerebrospinal fluid flow.- - - - - - - - - - ranking = 1keywords = dislocation (Clic here for more details about this article) |
8/75. Selective paralysis of the upper extremities after odontoid fracture: acute central cord syndrome or cruciate paralysis?A patient presented with selective paralysis of the arms after having sustained a fall. X-ray of the cervical spine showed a type II odontoid fracture with posterior atlantoaxial dislocation. The diagnosis in the emergency room was cruciate paralysis, which is frequently associated with fractures of axis and/or atlas. However, magnetic resonance imaging (MRI) of the cervical spine revealed a lesion consistent with the acute central cord syndrome (CCS) at the C2-C6 level. The patient underwent posterior atlantoaxial arthrodesis to correct instability and was discharged, without much neurological improvement. Cruciate paralysis has been reported to be associated with fractures of axis and/or atlas, and acute CCS has rarely been associated with the fractures. However, this case illustrates that the lesion responsible for selective paralysis of the upper extremities is not as specific as it had been thought to be, and that it is difficult to accurately identify the level of the cervical cord injury by neurological diagnosis and x-rays alone. Supplementary diagnostic modalities, particularly MRI, are required to make a correct diagnosis and develop a therapeutic strategy.- - - - - - - - - - ranking = 1keywords = dislocation (Clic here for more details about this article) |
9/75. A great misfortune: second traumatic spinal cord injury.OBJECTIVE: A second and a separate traumatic spinal cord injury, which results in neurological deterioration, is very rare. In this report we describe a patient who became tetraplegic after sustaining a second spinal trauma. CASE REPORT: A 27-year-old female had a C(7)-T(1) dislocation after a motor vehicle accident. She was neurologically intact and she had undergone a posterior fusion between C(6)-T(2). She made a complete recovery. Eight months after her initial trauma, she sustained a second motor vehicle accident causing a C(5) burst fracture. CONCLUSION: Second traumatic spinal cord injury is a rare entity. Motor vehicle accidents are the most common cause of this type of injury. Whatever the treatment strategy is, the best treatment modality for traumatic spinal cord injury is prevention.- - - - - - - - - - ranking = 1keywords = dislocation (Clic here for more details about this article) |
10/75. spinal cord injury in children.The spinal injured child has speical needs owing to the processes of physical, mental and social growth. goals of physical treatment programs include prevention of: genitourinary complications; contractures; pressure sores; long bone fractures, hip subluxation and dislocation; spinal deformity. Nonoperative treatment of spinal deformity employing external support should be initiated when the potential for spinal deformity exists. External support delays the development of spinal deformity, improves sitting balance and allows free upper extremity use. The overall treatment programs must consider altered body proportions, immaturity of strength and coordination. Case examples of children with spinal injury are presented above to illustrate specific problems stemming from immaturity of physical, cognitive, and social development. Spinal surgery can be a conservative measure in the growing child when there is radiologic evidence of progressive spinal deformity. Posterior spinal fusion with Harrington instrumentation and external support permits immediate return to vertical activity.- - - - - - - - - - ranking = 1keywords = dislocation (Clic here for more details about this article) |
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