1/160. Fracture-dislocation of the dorsal spine.A patient with fracture-dislocation of D9 on D8 had considerable posterolateral displacement. The neurologic injolvement of his left leg proved to be progressive. Treatment consisted of posterior decompression, exploration, open reduction and stabilization by means of Harrington rods, and fusion. All neurologic findings resolved completely. Final evaluation 18 months later showed a good and serviceable spine with no residual neurologic deficits. In my opinion, the treatment used in this case under given circumstances represented a reasonable modality of therapy.- - - - - - - - - - ranking = 1keywords = fracture, compression (Clic here for more details about this article) |
2/160. Detection of vertebral artery injury after cervical spine trauma using magnetic resonance angiography.BACKGROUND: We prospectively describe the incidence, magnetic resonance-based diagnosis, and treatment of vertebral artery (VA) injury resulting from closed cervical spine trauma. methods: patients with fracture or dislocation on plain radiographic studies underwent computed tomography. Among these patients, the subset with computed tomographic evidence of foramen transversarium (FT) fracture underwent magnetic resonance angiography as early as possible. RESULTS: During a 16-month period, 38 patients with closed cervical trauma were treated. Twelve patients demonstrated fracture extension through at least one FT by computed tomography. Among these patients, four showed unilateral VA injury by magnetic resonance angiography, all ipsilateral to the fractured FT. Three cases of VA occlusion and one of focal narrowing were demonstrated. All four patients were initially treated with aspirin, and two were systemically anticoagulated. None developed irreversible neurologic deficits from the VA compromise. CONCLUSION: Our data suggest that the incidence of VA injury in closed cervical spine trauma is significant and that FT fractures warrant flow-sensitive magnetic resonance imaging.- - - - - - - - - - ranking = 4.7526009453059keywords = fracture (Clic here for more details about this article) |
3/160. Traumatic L5-S1 spondylolisthesis: report of three cases and a review of the literature.The literature reports that traumatic spondylolisthesis of L5 is an uncommon lesion. The authors report their experience of three cases of this particular fracture-dislocation of the lumbosacral spine. They stress the importance of certain radiographic signs in the diagnosis: namely, the presence of unilateral multiple fracture of the transverse lumbar apophysis. As far as the treatment is concerned, they state the need for an open reduction and an internal segmental fixation by posterior approach. A preoperative MRI study appears mandatory in order to evaluate the integrity of the L5-S1 disc. In the event of a traumatic disruption of the disc, they state the importance of posterior interbody fusion by means of a strut graft carved from the ilium or, in case of iliac wing fracture (which is not uncommon in these patients), by means of interbody cages.- - - - - - - - - - ranking = 2.8515605671835keywords = fracture (Clic here for more details about this article) |
4/160. Spinal lesions, paraplegia and the surgeon.Thirty-six patients with spinal cord lesions and varying degrees of paraplegia were seen by the surgical team at the Angau Memorial Hospital, Lae, over a thirty month period. Because the continued presence of a spinal lesion may lead to progressive cord destruction and ischaemic myelopathy, prompt treatment is advocated. The depressing results that have followed treatment of fracture dislocations of the cervical spine and secondary neoplasm with paraplegia is recorded and some suggestions are made that may improve the outlook in future cases. Early and major surgery is advocated in the treatment of spinal abscesses, tumours, Pott's paraplegia and unstable fracture dislocations of the lumbar spine.- - - - - - - - - - ranking = 1.9010403781223keywords = fracture (Clic here for more details about this article) |
5/160. Atlantal stenosis: a rare cause of quadriparesis in a child. Case report.The authors report the case of a 3-year-old boy who suffered from quadriparesis and respiratory distress after failing to execute a somersault properly. neuroimaging revealed spinal cord contusion with marked spinal canal stenosis at the level of the atlas. No subtle instability, occult fracture, or other congenital abnormalities were confirmed. spinal cord contusion with marked canal stenosis is rare, and only several adult cases have been reported. Severe stenosis at the level of the atlas may predispose individuals to severe spinal cord contusion, as occurred in our patient after sustaining trivial trauma.- - - - - - - - - - ranking = 0.95052018906117keywords = fracture (Clic here for more details about this article) |
6/160. Hepatic ischemia as a complication after correction of post-traumatic gibbus at the thoracolumbar junction.STUDY DESIGN: This is a case report of hepatic ischemia secondary to celiac trunk stenosis as a complication after correction of a preoperative 30 degrees gibbus at the thoracolumbar junction. OBJECTIVES: A high index of suspicion is needed to make a timely diagnosis of hepatic ischemia in any setting. After spinal reconstruction involving lengthening, symptoms suggestive of an acute abdomen accompanied by markedly elevated liver enzymes should be evaluated with an angiogram to check for celiac trunk stenosis. SUMMARY OF BACKGROUND DATA: review of the literature showed no reported cases of hepatic ischemia or descriptions of the status of celiac trunk stenosis after spinal surgery. Even in more commonly associated settings, diagnosis of both phenomena is often delayed, with possible morbid consequences. methods: A case is presented of a patient who underwent gibbus correction and re-establishment of lost anterior intervertebral distance at the thoracolumbar junction. After surgery, ischemic hepatitis, a perforated gallbladder, and splenic infarction developed secondary to celiac trunk stenosis-a result of cephalad displacement of the celiac trunk and compression of the artery by the diaphragmatic ligament. RESULTS: An emergent exploratory laparotomy with cholecystectomy was performed followed by an angiogram, which demonstrated stenosis of the celiac trunk. After release of the arcuate ligament, the patient's condition improved rapidly, and he made a complete recovery. CONCLUSIONS: The consequences of a delay in diagnosis of hepatic ischemia can be disastrous. An awareness of the possibility of this complication after spinal lengthening should facilitate a timely angiogram and operative intervention.- - - - - - - - - - ranking = 0.049479810938827keywords = compression (Clic here for more details about this article) |
7/160. Masking of vertebral artery dissection by severe trauma to the cervical spine.STUDY DESIGN: A prospective case study was performed. OBJECTIVES: To illustrate the association of cervical trauma with vertebral artery dissection, and to propose a diagnostic and therapeutic algorithm for suspected traumatic vertebral artery dissection. SUMMARY OF BACKGROUND DATA: vertebral artery dissection is a recognized but underdiagnosed complication of trauma to the cervical spine. Symptoms of spinal cord injury, however, may obscure those of vertebral artery dissection, presumably causing gross underdiagnosis of this complication. methods: All patients with vertebral artery dissection admitted to the authors' facility between 1992 and 1997 were screened for cervical trauma. RESULTS: This article presents four patients with severe trauma to the cervical spine, defined as luxation, subluxation, or fracture, in whom symptoms of vertebral artery dissection developed after a delay ranging from several hours to weeks. The traumatic vertebral artery dissection typically was located at the site of vertebral injury or cranial to it. One patient with fracture of the odontoid process survived symptom free without ischemic brain infarctions. Another patient survived with traumatic quadriplegia in addition to large cerebellar and posterior cerebral artery infarctions. Two patients died as a result of fulminant vertebrobasilar infarctions, both with only moderate impairment from the primary spinal cord injury. CONCLUSIONS: Early signs of vertebral artery dissection include head and neck pain, often localized to the site of intimal disruption, which may be disguised by the signs of the spinal injury. Early Doppler ultrasound and duplex sonography as a noninvasive screening method should be performed for patients with severe trauma to the cervical spine. In cases of vertebral artery dissection, immediate anticoagulation should be initiated. Traumatologists should be aware of this complication in evaluating patients with severe trauma of the cervical spine, and also for a variety of forensic reasons.- - - - - - - - - - ranking = 1.9010403781223keywords = fracture (Clic here for more details about this article) |
8/160. Traumatic atlantoaxial distraction injury: a case report.STUDY DESIGN: Case report. OBJECTIVES: Description of a rarely reported variant of traumatic C1-C2 dislocation and discussion of a favorable outcome in a nonsurgical treatment approach. SUMMARY OF BACKGROUND DATA: Atlantoaxial dislocation most commonly involves an anterior movement of C1 in relation to C2. Often, the integrity of the transverse ligament or odontoid process is compromised, and the atlantodental interval changed. The described patient sustained a purely craniocaudal atlantoaxial distractive lesion secondary to injury sustained in a high-speed motor vehicle accident. RESULTS: The initial treatment plan involved surgical stabilization subsequent to healing of a C1 ring fracture. After 12 weeks of external stabilization, ligamentous damage appeared well resolved. That there was no gross instability delayed using a surgical option. At periodic checkup, the patient was without symptoms. CONCLUSION: In this case, conservative management of a ligamentous C1-C2 injury was effective. At 5 years after trauma the patient was without sequelae. This outcome is in contrast to previous management of injuries of this type, all of which involved surgical intervention.- - - - - - - - - - ranking = 0.95052018906117keywords = fracture (Clic here for more details about this article) |
9/160. Traumatic subluxation of the axis after hyperflexion injury of the cervical spine in children.Six cases of children (four boys and two girls, mean age 11 years) who had traumatic subluxation of the axis (C2) were reviewed retrospectively. Initial radiographs demonstrated no detectable vertebral fracture in any of the children. However, a slight anterior subluxation of C2 was observed in three of the patients. Radiographs, taken at 1 month after injury in all but one patient, revealed a progression of the subluxation and a local kyphosis in all of the patients. Four of the children were treated conservatively with a cervical brace, and an improvement of both the kyphosis and the anterior slippage of C2 was obtained accompanied by an anteroposterior growth of the C3 vertebral body. The kyphosis of two of the patients became severe and, ultimately, these patients underwent fusion surgery. At the follow-up, none of the patients presented with any significant symptom. For the correct diagnosis of traumatic subluxation of C2, sequential radiographs to confirm the progression of subluxation and local kyphosis are mandatory. Conservative treatment rather than early surgical treatment may be chosen for this injury, because mild and moderate kyphosis can be corrected spontaneously by remodeling of the cervical spine.- - - - - - - - - - ranking = 0.95052018906117keywords = fracture (Clic here for more details about this article) |
10/160. Cervical spine injury in patients with ankylosing spondylitis.Fractures of the cervical spine associated with ankylosing spondylitis are rare. Relatively minor injury can cause a fracture of the vertebral body or through the ossified intervertebral space, because of the loss of normal flexibility, mobility, and elasticity in the rigid spine. Sixty-six per cent of the fracture subluxations of the ankylosed spine are associated with injury to the spinal cord, and the mortality rate is 40%. Because of the complete nature of fracture and instability, there is a high risk of neurologic deterioration. immobilization of the cervical spine in a Halo cast appears to be the treatment of choice. If skull traction is applied the cervical spine should be immobilized in the neutral position, and overzealous traction exceeding 10 pounds should be avoided. Callus formation and fracture healing following immobilization is rapid. Four new cases are described and 44 previously reported cases in the literature have been reviewed.- - - - - - - - - - ranking = 3.8020807562447keywords = fracture (Clic here for more details about this article) |
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