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Objective:To explore the curative effect of anterior cervical surgery for lower cervical dislocation combined with spinal cord injury.Methods:A retrospective case series study was carried out to analyze the clinical data of 72 patients with lower cervical dislocation and spinal cord injury admitted in Beijing Boai Hospital, China Rehabilitation Research Center from January 2011 to August 2018, including 55 males and 17 females, with an average age of 35.8 years (range, 18-63 years). The segments of injury were at C 3 in 2 patients, at C 4 in 16, at C 6 in 24 and at C 7 in 30. Bases on American Spinal Injury Association (ASIA) grade, there included grade A in 43 patients, grade B in 22, grade C in 6 and grade D in 1. All patients were treated with anterior decompression and fusion. Operation time, intraoperative hemorrhage, decompression and fusion, complications and ASIA grade were observed. Results:All patients were followed up for 3-72 months (average 24.2 months). Operation time was 90-180 months [(118±58)minutes] and intraoperative bleeding volume was 50-180 ml [(104±30)ml]. Spinal cord was decompressed in all patients. The reduction was excellent in 58 patients (81%) and fair in 14 patients (19%). Fusion was confirmed in 48 patients (67%). The complications were improved after timely treatment, including cervical edema in 1 patient, laryngeal edema in 1, cerebrospinal fluid leakage in 4 and axial pain in 2. ASIA grade change of spinal cord injury: grade A were recovered to grade B in 2 patients, grade A to grade C in 1, grade B to grade C in 1, grade C to grade D in 2 ( P>0.05). Conclusion:For dislocation of lower cervical spine combined with spinal cord injury, anterior surgery can obtain good decompression, reduction and fusion effect, but it has limited help for improvement of neurological function.
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Objective To investigate the effect of problem-based learning (PBL) combined with evidence-based medicine (EBM) on clinical teaching for postgraduates of spinal cord injury rehabilitation. Methods Postgraduates who studied in our ward between April 2010 to March 2012 were enrolled as control group (n=12) and received traditional teaching. Postgraduates who studied in our ward between April 2012 to March 2014 were enrolled as test group (n=12) and received PBL combined EBM in addition. Their achievement of academic and practical (case analysis) tests were compared, and they were investigated with questionnaire of satisfaction. Results There was no signif-icant difference between the groups in achievement of academic and practical (case analysis) tests (P>0.05). The score of progressive knowl-edge was significantly higher in the test group than in the control group (P0.05). Conclusion PBL combined with EBM can improve the teaching for postgraduates majored in spinal cord injury rehabilitation.
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@#Objective To investigate the clinical characteristics of nontraumatic spinal cord injury, including the demographic characteristics,etiology and neurological function. Methods 44 patients with nontraumatic spinal cord injury in the past 4 years were reviewed. Results There were 27 males (61.3%) and 17 females (38.7%) with mean age of 39.85 years (3.5~78). They were followed up for mean of 13.3 (3~23) months. Myelitis (36%) and spinal tumor (including primary and metastatic tumor, 18.1%) were the most common causes, followed by intraspinal tumor (15.9%), vascular disease (13.6%), nontraumatic acute disc herination (6.8%), spinal cord ischemia after non-spinal surgery (4.5%) and hepatic myelopathy (4.5%). Neurological function at the initial admission included tetraplegia in 9 patients, paraplegia in 30 patients, conus medullaris syndrome in 2 patients and cauda equina syndrome in 2 patients. Neurological function of ASIA at the initial admission included A in 14 cases, B in 6, C in 13 and D in 11. 34% patients improved at least one ASIA grade when evaluated at final follow up. Conclusion Nontraumatic etiologies contribute to a significant proportion for spinal cord injury. Patients with nontraumatic spinal cord injury present the clinical characteristics different from traumatic spinal cord injury cases.
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BACKGROUND:The majority of studies focus on the lesions of spinal cord injury, while little evidence is available on the change of morphology and structure of distal nerve, muscle and motor endplates fol owing spinal cord injury. OBJECTIVE:To investigate the time window change of the morphology of motor neurons and skeletal muscles caudal to the lesion after spinal cord injury in rats. METHODS:Fifty healthy adult Sprague-Dawley rats were randomly divided into three groups:control group (n=5;without treatment), sham operation group (n=10), and spinal cord injury group (n=35). The sham operated rats only received laminectomy. In the spinal cord injury group, rats were subject to complete T 10 spinal cord injury by total laminectomy and cord transverse resection. Then the morphological change including sciatic nerve, motor endplate and median gastrocnemius was observed for each group at 1, 2, 4, 12, 24 weeks after injury. RESULTS AND CONCLUSION:(1) The myelin sheath layers of sciatic nerve were separated partial y at 4 weeks in rats with spinal cord injury, the myelin sheaths were fragmented with the regeneration of thin-myelinated and unmyelinated axons at 12 weeks. There was a decrease in myelinated axons and an increase in thin-myelinated and unmyelinated axons at 24 weeks. (2) The synaptic gutters of motor endplate, the presynaptic and postsynaptic membrane and synaptic space were distinct at 4 weeks in rats with spinal cord injury, the degenerated motor endplates coexsisted with the intact ones at 12 weeks. The motor endplate disappeared at 24 weeks. (3) There was a slight decrease in muscle cross-sectional area at 2 weeks in rats with spinal cord injury, but no structural change was found, the membrane of myocytes was partial y weakened at 4 weeks, the border of myocytes was obscure with hyperplasia of connective tissue at 12 weeks, and myocytes gathered and in fusion at 24 weeks. As natural history of completely transected spinal cord injury in rats, there were significant changes in morphology of peripheral nerve, motor endplate and skeletal muscles caudal to the lesion at 12 weeks, and the changes were destructive at 24 weeks.
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@#Objective To explore the factors related with bladder function after surgical intervention in patients with first lumbar burst fractures uniting isolated conus medullaris syndrome (CMS). Methods 25 patients complicated CMS in 618 patients with Ｌ1 burst fracture were analyzed retrospectively. Results The recovery rate of patients with saddle sensation weakness was higher than the patients with saddle sensation disappeared (P<0.05). There was no difference in bladder function between patients accepted surgery within 2 weeks and more than 2 weeks (P>0.05). Conclusion Saddle sensation before surgery related with the recovery of bladder function.
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@# 3 cases with esophageal fistula following anterior cervical fixation were reported. The diagnosis, treatment, nursing and prevention were summarized with literature.
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@#Objective To explore the effects of rehabilitation for adult cervical spinal cord injury without radiological abnormality. Methods 80 patients were studied retrospectively. Results The increase of motor score of anterior, posterior and conservative group were around 5, 2 and 2, whereas that of FIM were 11, 17 and 15, respectively. The changes of sensory score were uncertain.Conclusion The effect of surgical or conservative treatment is limited on neurological recovery, while rehabilitation can bring more functional independence to patients with cervical spinal cord injury without radiological abnormality.
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@# Objective To summarize clinical characteristics and treatment methods of cervical vertebrae injury in the elderly.MethodsThe data of 59 elderly patients with cervical vertebrae injury from 2002 to 2006 years were retrospectively reviewed.ResultsThe most common type of injuries was hyperextension injuries of cervical spine and cervial central cord syndrome.Traffic accident and falling injury were the most common reasons.Early operation and early rehabilitation could improve the ASIA 1 or 2 grade,and avoid complications of cord injury effectively.ConclusionThe key treatment point of cervical vertebrae injury in the elderly is how to get them leave bed in order to reduce the complications of cord injury,early operation and rehabilitation are good method to decrease the mortality and increase quality of life.
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@#Objective To summarize clinical characteristics and treatment methods of cervical vertebrae injury in the elderly.MethodsThe data of 59 elderly patients with cervical vertebrae injury from 2002 to 2006 years were retrospectively reviewed.ResultsThe most common type of injuries was hyperextension injuries of cervical spine and cervial central cord syndrome.Traffic accident and falling injury were the most common reasons.Early operation and early rehabilitation could improve the ASIA 1 or 2 grade,and avoid complications of cord injury effectively.ConclusionThe key treatment point of cervical vertebrae injury in the elderly is how to get them leave bed in order to reduce the complications of cord injury,early operation and rehabilitation are good method to decrease the mortality and increase quality of life.
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@#Objective To observe the effect of psychological nursing on anxiety after spinal cord injury.Methods60 inpatients were divided into group A(normal nursing)and group B(additional psychological nursing).They were evaluated with Self-Rating Anxiety Scale(SAS)when they were hospitalized and 1 month later.ResultsThe scores of SAS obviously decreased in both groups 1 month later(P<0.01),while that of group B were more obviously than group A(P<0.01).ConclusionThe routine nursing could relieve the anxiety symptoms of SCI patients.It is more effective in addition with psychological nursing and healthy education.
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[Objective]To assess whether the canal compromise and the location of conus medullaris determine neurological deficit in burst fracture of the first lumbar vertebra(L1).[Method]Twenty-seven consecutive patients with L1 burst fracture were collected in the study.The compressive ratios of anterior and posterior heights of fractured vertebral bodies,the remains to the estimated ones of the original vertebral bodies were measured on the radiogram,the extent of spinal canal compromise was assessed by computed tomography,and the location of conus medullaris was determined by the MRI examination.The neurological status was evaluated according to the standard neurological classification of spinal cord injury(ASIA).[Result]The compressive ratio of the anterior height was 0.63,the posterior height was 0.91,the stenotic ratio of the canal mid-sagital diameter was 0.69,the stenotic ratio of the distance between pedicles was 1.14,and the stenotic ratio of canal area was 0.83.The group having the stenotic ratio of canal area below 0.5 was at significant risk of neurologic involvement than the control [above(or equal to) 0.5(P=0.049)],and the group with lower conus medullaris had more serious neurological deficit than the upper ones(P=0.046).[Conclusion]There is a significant difference of neurological deficit between the groups with the spinal canal stenosis level of more than 50% and less 50%,and the group with lower conus medullaris had more serious neurological deficit than the upper one.
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@# ObjectiveTo investigate the effect of both conservative and surgical treatment on cervical spinal cord injury without fracture and dislocation.MethodsResultsAll patients had some recovery after both surgical and conservative treatment(P<0.05),but the patients after surgical treatment had a better outcome than those after conservative treatment(P<0.01).ConclusionThe effect of early surgical treatment on cervical spinal cord injury without fracture and dislocation is superior to conservative.
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@#ObjectiveTo observe the effect of surgical management on the thoracolumbar Chance fracture.Methods12 cases with thoracolumbar Chance fracture who accepted surgical management were followed-up 12 to 42 months(the mean was 21 months). ResultsDistraction deformity of posterior element were reduced significant in all patients, meanwhile, compression of anterior column was restored. Neurological function of all incomplete paraplegia patients improved their ASIA classification at least one grade. ConclusionSurgical treatment and internal fixation were suitable for stabilization of Chance fracture, neurological recovery and early rehabilitation.
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@#ObjectiveTo study the mechanisms and related factors and preventive managements of the stress ulcer complicating with acute cervical spinal cord injury. MethodsThe clinical findings of eight cases of the acute cervical spinal cord injury with stress ulcer were reviewed retrospectively.ResultsFive cases were cured by conservative treatment, one case was cured after operations, two cases died of breath and circulation failure.ConclusionStress ulcer is a critical complication of acute cervical spinal cord injury. It should be prevented actively.