1/27. midodrine for the management of orthostatic hypotension in patients with spinal cord injury: A case report.A 21-year-old man sustained anterior displacement and a burst fracture of C7 in a motor vehicle crash. He underwent anterior corpectomy, decompression, fusion of C6-T1 vertebrae, and halo placement. The American Spinal Injury association grade of his spinal cord injury (SCI) was C6 C tetraplegia. Severe orthostatic hypotension in the upright position complicated the patient's rehabilitation program. midodrine was prescribed, and other medications with possible adverse effects were adjusted. Significant improvement after taking midodrine was reflected in the orthostatic vital signs and symptoms, as well as in FIM instrument scores. Staff noted improvements with therapy participation and functional status. The patient tolerated the midodrine well and had no significant side effects.- - - - - - - - - - ranking = 1keywords = halo (Clic here for more details about this article) |
2/27. 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 = 6keywords = halo (Clic here for more details about this article) |
3/27. An unusual reduction technique prior to surgical treatment for traumatic spondylolisthesis in the lower cervical spine.Traumatic spondylolisthesis in the lower cervical spine is rare and only a few cases have been reported. We present a 56-year-old man who had severe C6-C7 spondylolisthesis without major neurological complications, caused by a traffic accident. Plain CT images showed a pedicular fracture on the right side and a laminar fracture on the left side at C6, but magnetic resonance images revealed no spinal cord compression. Application of a halo brace and maintaining the neck in slight flexion without traction resulted in reduction of the spondylolisthesis to nearly normal alignment. Anterior fusion using an autogeneous bone graft and a plate was easily performed without loss of correction. We suggest that preoperative reduction using a halo brace in slight flexion without longitudinal skull traction is useful and effective for severe traumatic spondylolisthesis in the lower cervical spine.- - - - - - - - - - ranking = 2keywords = halo (Clic here for more details about this article) |
4/27. Atlantooccipital distraction: a diagnostic and therapeutic dilemma: report of two cases.STUDY DESIGN: Two cases of severe atlantooccipital distraction, one with a fatal outcome and one with survival and 2 years of follow-up evaluation, are reported. OBJECTIVE: To show the problems in diagnosing and the dilemma in treating patients with severe atlantooccipital distraction in two cases with different outcomes. SUMMARY OF BACKGROUND DATA: Isolated severe traumatic atlantooccipital distraction without bony injuries is rarely seen in clinical practice. Because of high neurologic morbidity, most patients with the disorder are dead after the accident and before medical attention has arrived. However, because of improved immediate medical care for victims of motor vehicle accidents, an increased number of survivors are reported in the last years. methods: Two cases of isolated atlantooccipital distraction are described. The first case involved a 13-year-old cyclist hit by a car. In the second case, a 40-year-old woman sustained a severe accident as a motorcycle driver. Both patients were found to have severe atlantooccipital distraction on the lateral topogram of the computed tomography. In both cases, the initial MRI of the craniocervical junction failed to show medullary contusion. The diagnosis of severe medullary contusion was made by follow-up MRI performed 48 hours later. RESULTS: Both patients were treated initially with halo vest. Patient 1 survived the injury with tetraplegia and was referred to a spinal center for rehabilitation. At this writing, he is improving neurologically. Patient 2 did not recover and died 4 days after delivery to the neurosurgical intensive care unit because of circulatory failure. CONCLUSIONS: Because of high neurologic morbidity and mortality, atlantooccipital distraction represents a diagnostic and therapeutic problem. The therapy should be symptomatic, with life supporting measures, allowing the recovery of consciousness and then further neurologic evaluation.- - - - - - - - - - ranking = 1keywords = halo (Clic here for more details about this article) |
5/27. Progressive neurodegenerative disease in presumed spinal cord injury: case report of a patient with prion disease.BACKGROUND: prion diseases or transmissible spongiform encephalopathies (TSEs) are neurodegenerative syndromes caused by proteinaceous infectious particles (or "prions"), are fatally progressive, and affect humans and animals. Human prion disease may be familial, sporadic, or due to iatrogenic causes. The signs and symptoms include dementia, ataxia, myoclonus, dysautonomia, pyramidal and extrapyramidal tract signs, and akinesia. The incubation period of iatrogenic TSE ranges from 15 months to 30 years, and clinical presentations may be atypical. DESIGN: Case report. FINDINGS: This article presents the case study of a 39-year-old man who fell at work and subsequently complained of subjective lower extremity weakness, followed by onset of ataxia, bowel and bladder incontinence, and progressive decline in ambulation over 6 months. In the absence of a unifying diagnosis, the patient was presumed to have had a spinal cord injury (SCI). Because neuro-axis imaging studies failed to explain his symptoms, the patient's complaints were thought to have a large psychologic component. The patient then developed neurologic abnormalities proximal to the presumed SCI. Somatosensory evoked potentials were suggestive of a thoracic or lumbar cord myelopathy and cerebrospinal fluid analysis was suggestive of prion disease. family members eventually revealed that the patient had had injections of growth hormones derived from cadaveric human pituitary glands as a child. Postmortem brain examination later revealed definitive Creutzfeldt-Jakob disease.- - - - - - - - - - ranking = 1keywords = halo (Clic here for more details about this article) |
6/27. Multiple unstable cervical fractures with cord compromise treated nonoperatively: a case report.STUDY DESIGN: The case of a 17-year-old boy who sustained an unusual pattern of multiple unstable cervical spine fractures with a spinal cord injury is presented. OBJECTIVE: To review the management and treatment of multiple unstable cervical spine fractures. SUMMARY OF BACKGROUND DATA.: Combined unstable cervical spine injuries are uncommon. Treatment of multiple-level cervical spine fractures remains controversial. methods: The case of a 17-year-old boy who sustained a ring fracture of the atlas, an atypical traumatic spondylolisthesis of the axis, bilateral pedicle fractures of C3 with significant anterior subluxation of C3 on C4, a C6 burst fracture, compression fractures of C7 and T1, and significant cord compression as the result of a motor vehicle accident is presented. RESULTS: The patient was successfully treated with an initial closed reduction using cervical traction for 1 week followed by placement of a cervical halo vest. The fractures healed successfully, and the patient regained near-normal neurologic function. CONCLUSIONS: Despite advances in the surgical treatment of cervical fractures and dislocations, nonoperative treatment with halo immobilization remains a viable option for selected complex injury patterns.- - - - - - - - - - ranking = 2keywords = halo (Clic here for more details about this article) |
7/27. Pin-site myiasis: a rare complication of halo orthosis.STUDY DESIGN:Case report.OBJECTIVE:To report a rare complication following halo placement for cervical fracture.SETTING:united states University teaching Hospital.CASE REPORT:A 39-year-old woman who sustained a spinal cord injury from a C6-7 fracture underwent halo placement. She subsequently developed an infection adjacent to the right posterior pin, which then became infected with diptera larvae (maggots), necessitating removal of the pin and debridement of the wound site.CONCLUSION:Halo orthosis continues to be an effective means of immobilizing the cervical spine. incidence of complications ranges from 6.4 to 36.0% of cases. Commonly reported complications include pin-site infection, pin penetration, pin loosening, pressure sores, nerve injury, bleeding, and head ring migration. Pin-site myiasis is rare, with no known reports found in the literature. Poor pin-site care by the patient and her failure to keep follow-up appointments after development of the initial infection likely contributed to the development of this complication.- - - - - - - - - - ranking = 6keywords = halo (Clic here for more details about this article) |
8/27. Fatal hyperthermia in a quadriplegic man. Possible evidence for a peripheral action of haloperidol in neuroleptic malignant syndrome.A patient with a cervical cord transection isolating his hypothalamic thermoregulatory centers from peripheral effectors suffered a fatal hyperthermic episode after receiving haloperidol. This suggests that neuroleptic malignant syndrome is caused by a peripheral, not central, effect of haloperidol.- - - - - - - - - - ranking = 6keywords = halo (Clic here for more details about this article) |
9/27. cerebral hemorrhage due to autonomic dysreflexia in a spinal cord injury patient.STUDY DESIGN: Case report. OBJECTIVE: To report an uncommon case of cerebral hemorrhage due to autonomic dysreflexia (AD) in a spinal cord injury (SCI) patient. SETTING: Institut Guttmann, Neurorehabilitation Hospital in Barcelona, spain. CASE REPORT: An SCI patient developed AD due to urinary tract infection after surgery for a pressure sore. The hypertension was difficult to control and the case progressed to hypertensive encephalopathy. MRI of the brain was performed showing a hemorrhagic lesion on the left occipital area. The hypertension was finally controlled and the neurological status improved although with some cognitive deficits. CONCLUSION: This is an uncommon case of cerebral hemorrhage due to AD, showing the importance of an adequate diagnosis and treatment of AD to avoid this life-threatening complication.- - - - - - - - - - ranking = 1keywords = halo (Clic here for more details about this article) |
10/27. Failure of standard imaging to detect a cervical fracture in a patient with ankylosing spondylitis.STUDY DESIGN: Retrospective case study of 38-year-old male with ankylosing spondylitis who presented with a brown-sequard syndrome following a fall and an occult fracture on initial spinal imaging studies. OBJECTIVE: To review the recommended imaging protocol in a patient with ankylosing spondylitis and a suspected cervical spine fracture. SUMMARY OF BACKGROUND DATA: Plain radiographic imaging using orthogonal views can detect the majority of spinal fractures. However, fracture identification is particularly difficult in patients with ankylosing spondylitis. Of the various contemporary imaging methods, [magnetic resonance imaging (MRI), computed tomography (CT), nuclear scanning] high-definition multidetector CT scanning is the most useful in identifying subtle fractures, but in metabolic bone diseases the utility of these methods is unknown. methods: Retrospective radiographic evaluation of imaging studies of ankylosing spondylitis patient with occult fracture by five spine surgeons and neuroradiologists, followed with detailed review and interpretation of literature concerning present radiology techniques and methods to isolate occult fractures. RESULTS: Initial imaging studies, including plain radiographs of the spinal axis, cervical and thoracic single-detector CT with reconstructed images, and MRI, were unremarkable in detecting an occult cervical spine fracture in a patient with ankylosing spondylitis and a spinal cord injury following a fall. The patient was placed empirically in a halo orthosis and a high definition multidetector CT scan was obtained. This study demonstrated a transverse fracture through the fused C6-C7 spinal level. CONCLUSION: Occult fractures in ankylosing spondylitis may not be apparent on routine plain radiographic and MRI studies. In the setting of ankylosing spondylitis, a high index of suspicion must be maintained in all patients presenting with spinal pain following even minor trauma. High-resolution multidetector CT imaging appears to be more sensitive and accurate in the diagnosis of fractures in this patient subgroup than other contemporary imaging methods.- - - - - - - - - - ranking = 1keywords = halo (Clic here for more details about this article) |
| | Next -> |