Aplicación de magnetoterapia y craneopuntura en un paciente con cuadriparesia / Use of magnetotherapy and craneopuncture in a patient with quadriparesis

Se presenta el caso clínico de un paciente con diagnóstico de cuadriparesia debido a una fractura vertebral cervical y compresión medular graves, producidas por una caída desde una altura de 2 metros. Según el examen físico, los estudios radiológicos y la aplicación de escalas neurológicas, presentaba pérdida total de la función motora, de la discriminación sensorial del dolor y de la temperatura por debajo del nivel de lesión. Debido a las secuelas de las lesiones traumáticas en el sistema nervioso central, se aplicó tratamiento bioenergético rehabilitador: magnetoterapia y craneopuntura, complementado con kinesioterapia y terapia ocupacional, y se obtuvo una mejoría de la fuerza, el tono muscular y la capacidad funcional, con coordinación de la marcha.

The case report of a patient with diagnosis of quadriparesis due to a cervical vertebral fracture and severe medullary compression, taking place due to a fall from a height of 2 meters is presented. According to the physical examination, the radiological studies and the use of neurological scales, he presented total loss of the motor function, of the sensorial discrimination of pain and of temperature under the lesion level. Due to the sequels of the traumatic lesions in the central nervous system, bioenergetic rehabilitative treatment was applied: magnetotherapy and craneopuncture, supplemented with kinesiotherapy and occupational therapy, and an improvement of the force, the muscle tone and the functional capacity, with coordination of walking was obtained.

Cervical vertebral fracture: A report of two cases of “Near-Miss” C6 fractures

ervical spine injury is commonly associated with road-traffic accidents. The true incidence of cervical spine injuries is unknown due to under-reporting of such injuries. Cervical spine injury is associated with high morbidity and mortality if it is missed. With the advancement of imaging modalities, the number of missed cervical injuries has reduced. Nevertheless, some clinicians are dependent solely on imaging tools to rule out cervical spine injury in a trauma victim. We report two cases of “near miss” C6 fracture to highlight the importance of a detailed clinical history and clinical examination with imaging as an adjunct to rule out cervical injury.

Motion Induced Artifact Mimicking Cervical Dens Fracture on the CT Scan: A Case Report

The diagnostic performance of helical computed tomography (CT) is excellent. However, some artifacts have been reported, such as motion, beam hardening and scatter artifacts. We herein report a case of motion-induced artifact mimicking cervical dens fracture. A 60-year-old man was involved in a motorcycle accident that resulted in cervical spinal cord injury and quadri plegia. Reconstructed CT images of the cervical spine showed a dens fracture. We assessed axial CT in detail, and motion artifact was detected.

Posterior Fixation of a Cervical Fracture Using the RRS Loop Spine System and Polyethylene Tape in an Elderly Ankylosing Spondylitis Patient: A Case Report

An 80-year-old woman presented with neck pain and paraparesis of Frankel C in her upper and lower extremities after falling. Imaging revealed an ankylosing cervical spine and a fracture line running obliquely from the anterior C3-4 to the posterior C4-5 level. Posterior fixation from the occi pit to T3 was performed using the RRS Loop Spine System and concomitant polyethylene tape fixation. This system is characterized by the uniqueness of how it screws to the occi pit and its use of a fixation rod with a larger diameter than in other instrumentation devices for use in the cervical region. Sublaminar banding using polyethylene tape was used to secure fixation. Her postoperative course was unremarkable, and her neck pain was relieved, although neurological improvement was minor. To our knowledge, this is the first report of an application of the RRS Loop Spine System to an ankylosing spondylitis patient with a cervical fracture.

Clinical Outcomes of Halo-Vest Immobilization and Surgical Fusion of Odontoid Fractures

OBJECTIVE: In the present study, authors retrospectively reviewed the clinical outcomes of halo-vest immobilization (HVI) versus surgical fixation in patients with odontoid fracture after either non-surgical treatment (HVI) or with surgical fixation. METHODS: From April 1997 to December 2008, we treated a total of 60 patients with upper cervical spine injuries. This study included 31 (51.7%) patients (22 men, 9 women; mean age, 39.3 years) with types II and III odontoid process fractures. The average follow-up was 25.1 months. We reviewed digital radiographs and analyzed images according to type of injury and treatment outcomes, following conservative treatment with HVI and surgical management with screw fixation. RESULTS: There were a total of 31 cases of types II and III odontoid process fractures (21 odontoid type II fractures, 10 type III fractures). Fifteen patients underwent HVI (10 type II fractures, 5 type III fractures). Nine (60%) out of 15 patients who underwent HVI experienced successful healing of odontoid fractures. The mean period for bone healing was 20.2 weeks. Sixteen patients underwent surgery including anterior screw fixation (6 cases), posterior C1-2 screw fixation (8), and transarticular screw fixation (2) for healing the odontoid fractures (11 type II fractures, 5 type III fractures). Fifteen (93.8%) out of 16 patients who underwent surgery achieved healing of cervical fractures. The average bone healing time was 17.6 weeks. CONCLUSION: The overall healing rate was 60% after HVI and 93.8% with surgical management. Patients treated with surgery showed a higher fusion rate and shorter bony healing time than patients who received HVI. However, prospective studies are needed in the future to define better optimal treatment and cost-effective perspective for the treatment of odontoid fractures.

Comparative study on anterior cervical surgery by microendoscopic and open operation / 中国矫形外科杂志

[Objective]To complete comparison between anterior cervical surgery by microendoscopic and open operation,explore feasibility and efficacy of anterior cervical decompression,interbody fusion and fixation by microendoscopic surgery,and give preliminary clinical evaluation of mieroendoscopic surgery.[Method]In a retrospective study,46 patients underwent one level cervical surgery by anterior approach.23 patients(23~64 years,41.5 years in average)were treated with microendoscopic surgery as microendoscopic group.Under general anesthesia,a transverse incision(1.6 cm)was made at right side of neck.A tubular retractor was then inserted and fixed,and a specially designed endoscope was placed inside the tubular retractor.Discectomy and interbody fusion with insertion of Cage or/and plate fixation was performed by endoscope.At fracture and dislocation patient group,titanium Cage was used in 1 case,CBK in 1 case,plate in 5 cases.At cervical disc herniation patient group,titanium Cage was used in 2 cases,CBK in 12 cases,plate in 2 cases.During the same period,23 patients(25~68 years,46.5 years in average)were treated with open surgery as open group.A transverse incision(4～5 cm)was made by right route approach.Discectomy and interbody fusion with Cage or/and plate fixation was performed by general procedure.[Result]At microendoscopic group,23 cases were followed up from 10 to 22 months(16.5 months in average),and mean operative time were 95 minutes,mean blood loss 90 ml.For fracture and dislocation patients,by Frankels classification,2 cases with complete tetraplegia showed no improvement,2 cases with incomplete tetraplegia improved from grade C to grade D postoperatively,1 case upgraded from C to E.For cervical spondylotic myelopathy patients with disc herniation,according to Odoms scoring system,10 cases had excellent outcome,5 good,1 fair.At open group,23 cases were followed up from 8~21 months(15.2 months as average),and mean operative time was 95 minutes,mean blood loss 90 ml.By Frankels classification,2 cases with complete tetraplegia had no improvement,3 cases with incomplete tetraplegia improved from C to D,1 case from D to E.According to Odoms scoring system,8 patients suffering from cervical spondylotic myelopathy with disc herniation had excellent result,6 good,2 fair.[Conclusion]Compared with open surgery,microendoscopic surgery with endoscopic instrument and technique can be used for one level discectomy,interbody fusion and internal fixation,and offer a similar short-term good clinical outcome with minimal incision,less traumatic reaction and postoperative discomfort.

Therapeutic options to treate subaxial cervical fracture-dislocation with locked-facet / 中国矫形外科杂志

[Objective]To evaluate a simple,safty and effective therapeutic option to treate subaxial cervical fracture-dislocation with locked-facet.[Method]With the patients being awake and supervized under X-ray fluoroscopy,the authors used the early and continued closed skull traction-reduction to treate 16 cases of traumatic subaxial cervical fracture-dislocation with locked-facet.Before the beginning of the treatment,all the patients were taken for X-ray plain films and MRI/CT examinations as well as American Spinal Injury Association(ASIA) neurological function grade.The dynamic ASIA neurological function scale and X-ray fluoroscopy examnations were asked during the skull traction–reduction procedures.The average interval from the traumatic events to begin to skull traction–reduction was 31 hours(6-52 hours).The authors would continue the skull traction to maintain the anatomy position as soon as they succeeded in reducing the dislocation with locked-facet,forthmore they would take the anterior operation or combinations with anterior and posterior operations during the best condition.[Result]The MRI scans showed that there were 8 disc hernations and 5 disc disruptions at the dislocation levels before traction–reduction procedures.The ASIA scale were 7 grade C,5 grade D and 4 grade E,respectively.All the 16 cases succeeded in reduction as well as no neurological deterioration occurred.The postreduction MRI scans showed that 2 disc herations had converted to nearly normal disc position and another 4 disc hernations remained unchanged.Accordingly,2 disc disruption remained unchanged and another case had converted to disc hernation.The average traction weight was 19 kg(10~32 kg) and average traction time was 53 minutes(30~135 minutes).[Conclusion]Under the intensive dynamic ASIA neurological function grade and X-Ray fluoroscopy examnations,with the patients being awake and co-operation,the early and continued closed skull traction-reduction and then performing elective anterior or anterior-posterior surgery depending on the patient's overall and local status to treate subaxial cervical fracture-dislocation with locked-facet is safe and effective.

Selection of Surgical Approaches for Cervical Fracture-Dislocation

OBJECTIVE: In this study, we retrospectively evaluate the surgical outcome of the cervical fracture-dislocation in order to define the criteria for the operative approach selection based on fracture characteristics. METHODS: Thirty one consecutive patients (29 males and 2 females) who underwent operation for the cervical fracture-dislocation between 1997 and 2001 at a single institute were included in this study. Plain X-ray, computed tomography, and magnetic resonance imaging studies were performed in all patients. Injuries were characterized using Denis's three-column plain X-ray model, Daffer's computed tomography, and Oner's magnetic resonance imaging classifications. The Frankel classification was used for neurological deficits. The mean postoperative follow-up period was 11.93 months (range 1-61 months). RESULTS: The anterior approach was performed in 14 and the posterior approach in 10 of the 31 patients, respectively. Both anterior and posterior fixation was performed electively in 7 of the 31 patients. Daffer and Oner's classification was found to be able to predict surgical failures by either the anterior or the posterior approach. Three-column injury was misinterpreted as two-column injury only by plain radiography. No differences in neurological outcome, pain relief, or bone fusion rate were observed between the anterior approach and the posterior approach. However, the posterior approach was associated more frequently with postoperative kyphosis and instability. CONCLUSION: Surgical approach is usually determined on the basis of whether the compression is ventral or dorsal. Anterior fixation only may be an alternative to both anterior and posterior fixation in three-column injury, but posterior fixation alone is not.

Spinal Epidural Hematoma Associated with Cervical Fracture in Ankylosing Spondylitis / 대한척추외과학회지

A spinal epidural hematoma is a very rare condition, but it is a neurological emergency that requires urgent investigation and treatment, as it can lead to neurological sequelae, such as quadriplegia, in many cases. With a traumatic epidural hematoma associated with ankylosing spondylitis, the clinical course progresses more rapidly, and the prognosis is thought to be worse than that without ankylosing spondylitis. The mainstay of treatment is an urgent surgical decompression and evacuation of the hematoma, via a laminectomy, in the patients' that develop progressive neurological deterioration. However, there have only been a few reports on the successful conservative treatment of selective patients, with incomplete and nonprogressing deficits, where the symptoms and signs have resolved without surgery. We report on a patient with a traumatic epidural hematoma, associated with cervical fracture in ankylosing spondylitis, treated conservatively with an excellent neurological outcome.

Progress in research on vertebral artery injury resulting from blunt cervical spine trauma / 中华创伤骨科杂志

Articles about vertebral artery injuries secondary to blunt cervical spine trauma are increasing recently. The incidence of the disorder is reported from 19.4% to 46% in the literature. It has been found that unilate ral facet dislocations and bone fragments in the foraminal canal (comminuted fr acture of the foramen transversarium) have a significant association with the vertebral artery injuries,and that rotational violence may be a significant fac tor in causing vertebral artery occlusion. Patients with vertebral artery injuri es may have such symptoms as blurry vision, syncope, dysphagia and Wallenbergs syndrome. MRA(magnetic resonance angiography) is noninvasive and easy to per form at the time of initial MR. A routine evaluation of the extracranial circula tion with MRA should be performed as an additional sequence to all initial MR of the cervical spinal cord injury. Conventional angiography may be indicated only if the patient develops symptoms of cerebral ischemia. The benefit of antithrom botic therapy in reducing neurological morbidity and improving outcome has not y et been established and needs long-term follow-up. Operative management should be reserved only for patients with severe active bleeding or when interventiona l radiology fails. The surgical exposure is complex and demands excellent knowle dge of the local anatomy.

Early Closed Reduction in Patients with Cervical Fracture-Dislocation Injury without Prior Magnetic Resonance Imaging

OBJECTIVE: We report an evaluation of incidence of the traumatic disc herniation and an effect of early closed reduction without prior magnetic resonance(MR) imaging in cervical spine fracture-dislocation injury. METHODS: The medical records and radiologic images of twenty consecutive traumatic cervical spine injury from the C2-3 to C7-T1 were reviewed. The disc injury on MR images was divided into two category: a herniation defined as deforming the thecal sac or nerve root and a disruption defined as a disc with high T2-weighted signal characteristics. Closed reduction was attempted in all patients and neurologic status was measured on admission and following reduction. MR image was obtainted within three days after early closed reduction. RESULTS: Early closed reduction by Gardner-Wells skeletal traction and serial plain radiography was achieved in 90% of patients and there was no associated neurological deterioration after reduction. The incidence of disc injury at the level of the fracture subluxation on the postreduction MR images was 60%(herniation-30%, disruption-30%), but the presence of disc herniation or disruption did not affect the degree of neurological recovery, as measured by American Spinal Injury Association(ASIA) motor score and the Frankel scale following early closed reduction. The average ASIA motor score prior reduction was 48.4 compared with 62.5 following reduction. CONCLUSION: Although disc herniation and disruption can occur following traumatic cervical fracture-dislocation, the actual incidence of neurological deterioration following early closed reduction is rare. Therefore, immediate closed reduction using traction in patients with any neurological deficit can be safe and effective before MR imaging.

Treatment of fresh femoral cervical fracture by closed reduction with percutaneous knowledpins

Management of fresh femoral neck fractures by closed reduction with percutaneous knowles pins in the past 17 years in CTO. From 1983 to this year, 2,412 patients with fresh femoral cervical fractures were treated by closed reduction with percutanous knowles pins through 3 periods. Percutaneous pining become the main procedure in treament of fresh femoral neck fractures in Center for Traumatology and Orthopaedics at least 1-4 cases a days with good results especially for the elderly patients. They can wake up the days after surgery. This method was also realized in developed countries at the end of the years 70. With very small incisions, minimal influence for the body, percutanous pinning enhanced the recovery, shortened the hospital time and lowered treatment fees.

The primarily results of the operation of the semi hip joint replacement in the treatment of the femoral bone cervical fracture in elderly

7 patients with the femoral bone cervical fracture with the average ages of 70.2 (male: 02; female: 05) received the semi-hipjoint replacement. The results have shown that all patient had the 1st phase skin healing.. post- operative X-ray found the location correctly. The thigh was not ruptured or perforrated. The average duration of treatment: 25 days. Conclusions: the operation of the hip joint replacement contributed to last the patient’s life, help the patients early walking, prevent the complication and false joint or fermoral spheroidal osteoclast.

A Clinical Analysis of Treatment of Cervical Fracture and Dislocation

Recently, the authors experienced the thirty-one cases of cervical fracture and dislocation. Among them, nineteen cases underwent surgical treatment and remained conservative treatment. There are three ways in operation ; 1) anterior approach(Cloward, Smith-Robinson method). 2) posterior approach. 3) combined approach(modified Smith-Robinson and posterior fusion). We did a combined approach and the results were excellent.

Removal of Huge Cervical Intraspinal Fragment Demonstrated Only by CT Scan

Cervical traction has been widely used as an essential method for the treatment of cervical fracture-dislocation. This report, however, was a case in which hazardous effect of traction due to unreduced huge fragment was demonstrated only by cervical CT scan. Surprisingly plain X-rays could not demonstrated this condition. It was apparent that skeletal traction resulted in further injury of the spinal cord. Surgical removal of unreduced huge fragment was accomplished completely and interbody fusion was followed. Postoperative CT findings showed complete removal of fragment and decompression of the spinal cord as well as gratifying interbody fusion. CT scanning is imperative to evaluate the cervical fracture-dislocation and blind skeletal traction may be hazardous.