Cases reported "Spinal Injuries"

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1/34. Use of breath-activated Patient Controlled analgesia for acute pain management in a patient with quadriplegia.

    We report the use of breath-activated Patient Controlled analgesia (PCA) for the provision of analgesia in a quadriplegic patient with traumatic neck injury. This provided good pain relief, decreased opioid complications, improved perceptions of self-control, smoothed recovery and enhanced patient, family as well as staff satisfaction. The setup and principles of its use in a patient with high anxiety and unable to use conventionally activated PCA are illustrated.
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2/34. 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.
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3/34. La maladie de Grisel: spontaneous atlantoaxial subluxation.

    Objective: "La maladie de Grisel" (Grisel's syndrome) is a spontaneously occurring atlantoaxial subluxation with torticollis. We present a case of atlantoaxial subluxation occurring in a 20-year period of pharyngoplasty surgery. The occurrence of a "spontaneous" atlantoaxial subluxation after oral cavity or pharynx operations is rare. Because some neck pain and stiffness are commonly seen after these kinds of operations, we would like to draw attention to this unusual complication. Symptoms associated with a torticollis after an operation in the oral cavity or pharynx requires additional investigation to exclude this rare complication. A review of the available literature concerning etiology and treatment of la maladie de Grisel is presented.
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4/34. 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.
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5/34. Cervicocranium and the aviator's protective helmet.

    An analogy based on the likenesses of the APH-6 aviator's protective helmet and the hangman's noose has some interesting relationships to aircraft accident investigation and to the associated traumatic pathology. A superficial examination of the similarities might propose that the inferior edge of the helmet, when considered part of the continuous circle completed by the nape strap and the chin strap, forms a loop which can be likened to a hangman's noose. The analogy might be extended to the comparison of lesions made about the neck by the straps or the edge of the helmet compared with abrasions and contusions that might be associated with a rope encircling the same structures. Such a hangman's noose, when the knot is at the side of the head (subaural), produces fractures of the base of the skull tending to extend bitemporally through the basisphenoid. When the knot is anterior and beneath the chin (submental), the hangman's noose causes a fracture dislocation at the axis. Characteristically, the posterior arch is fractured and, interestingly enough, the odontoid process is not involved. Many of us anticipate that a fractured, displaced odontoid process is the prototype lesion which so precariously endangers the patient with cervical cord compromise and death similar to the hangman's fracture. More recent assessments of the mortality of the odontoid fracture suggest less than 10%.
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6/34. Industrial medicine and acute musculoskeletal rehabilitation. 2. Acute cervical spine and shoulder injuries in the industrial setting.

    This self-directed learning module highlights the underlying anatomy and biomechanics of the cervical spine and shoulder as a basis for developing a differential diagnosis of contributing pathology in an industrial injury. This includes components of the history, examination, and appropriate diagnostic testing that are necessary to develop an optimal rehabilitation plan. Treatment options are reviewed and include medications, therapy, selective injections, and return-to-work programs in the industrial setting. overall ARTICLE OBJECTIVES: (a) To be able to identify neck and shoulder pathology, (b) to effectively evaluate cervical spine and shoulder injuries, and (c) to rehabilitate acute cervical spine and shoulder injuries in the industrial setting.
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7/34. Spinal injury considerations in the competitive diver: a case report and review of the literature.

    BACKGROUND CONTEXT: Despite significant literature associated with spinal injuries and recreational diving, few articles exist regarding competitive diving injuries, with no reports pertaining specifically to spinal injuries. As a result, a case report of a collegiate diver with C5-C6 ligamentous instability requiring operative stabilization is currently presented in addition to a review of the literature. PURPOSE: Present a case report of cervical C5-C6 ligamentous instability in a collegiate diver. STUDY DESIGN: Case report and literature review. methods: Not applicable. RESULTS: Not applicable. CONCLUSIONS: diving injuries pertaining to competitive diving do occur but to a lesser extent than would be expected given the large forces the spine experiences. Training, experience and appropriate technique greatly minimize potential spinal hazards. Persistent complaints of neck pain after a competitive diving injury mandate aggressive evaluation and further workup.
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8/34. Speed bump-induced spinal column injury.

    INTRODUCTION: Compression fracture of the vertebral body is common, especially in older adults. Injuries to the spinal column are one of the most frequent injuries by accidents and falls from heights. Vertebral fracture associated with minor trauma, however, is a rare occasion. CASE REPORT: Five cases were injured in the inner city buses after passing onto speed bumps are presented. On presentation, four patients complained of severe pain in the thoracolumbar region, while in the other patient, physical examination revealed pain and tenderness on the neck. No neurologic deficit was noted except for one patient with tenderness on thoracic spines. Examination of the thoracolumbar X-ray and computed tomography displayed compression fractures in four patients. Other laboratory data obtained on admission were within normal limits. Posterior instrumentation was applied to three patients. All patients recovered well except for the one with cervical fracture. CONCLUSION: Drivers should be strongly warned and educated on the potential hazards of traversing past such bumps in roads too fast and such barriers should be built regarding tested standards.
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9/34. Gunshot injury to the face with a missile lodged in the upper cervical spine without neurological deficit.

    An unusual case of facial gunshot injury with the missile lodged in the cervical spinal canal, but without any neurological impairment is reported. The extent of tissue damage and missile track termination in a male patient who sustained gunshot trauma to the face was assessed by plain radiography and by CT scans. The patient was treated conservatively and observed for clinical manifestations of neurological deficit for 3 weeks. CT of the head and neck performed 13 years after injury with the three-dimensional (3D) reconstruction of skeletal elements revealed healed fractures of the right nasal bone, the labyrinth of the right ethmoid bone, and position of the missile on the medial aspect of the right lateral mass of the atlas. There was no migration of the missile during this period. This case report of gunshot wound to the face associated with injury of the cervical spine indicated possibility of survival and atypical absence of clinical manifestation that may occur even when a bullet remains in the spinal canal.
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10/34. Management of unstable cervical spine injuries in southern iraq during OP TELIC.

    INTRODUCTION: Cervical spine fractures and dislocations are uncommon injuries that can have serious neurological consequences. These injuries require adequate stabilisation to prevent further spinal cord injury during transfer between hospitals. Evacuation often requires a combination of road ambulance, helicopter and fixed wing aircraft from military hospitals. This paper outlines the neck injuries sustained during Op Telic and discusses the need for Halo vests to be available at role 3. METHODOLOGY: The MND(SE) Hospital databases were used to identify all casualties admitted with either a "Cervical" or "Neck" injury. The databases covered the period from 24 March 2003 until 15 April 2004. The diagnoses were categorised into minor and serious cervical spine injuries. We defined a serious cervical spine injury as either a fracture or dislocation. We looked at the discharge letters of all casualties evacuated to a role 4 hospital to confirm whether the casualties had serious cervical spine injuries. RESULTS: Forty seven casualties were admitted and all were British except three, two Iraqi civilians and one US soldier. Thirty three casualties were returned to their unit for duty, or discharged at the airhead on return to the UK. Fourteen casualties required hospital treatment. There were five serious cervical spine injuries over the study period which included one Hangman's fracture of C2, one flexion compression injury of C5, one flexion compression injury of C7, one unifacetal dislocation and one bifacetal dislocation. CONCLUSIONS: Five casualties were treated at MND(SE) Hospital for serious injuries to the cervical spine. Two patients were transferred without Halo stabilisation after failing to obtain halos in iraq. One casualty was kept until a Halo was flown out from the UK. RECOMMENDATIONS: All unstable cervical spine fractures should be stabilised with a Halo Vest prior to transfer from role 3. Halo Rings and Vests should be available at role 3 facilities.
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