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Objective:To study the correlation between the acute-phase characteristics of motor evoked potential (MEP) and severities of spinal cord injury in patients with acute cervical hyperextension injury and central cord syndrome (CCS).Methods:Retrospectively analyzed were the data of 45 patients with acute cervical hyperextension injury and CCS (observation group) who had been admitted to Department of Orthopedics, Tongji Hospital Affiliated to Tongji University from December 2018 to July 2021 and 20 healthy controls. Examination of transcranial magnetic stimulation-induced MEP was performed in patients with CCS and healthy controls using a magpro x100 magnetic stimulator, and recording was conducted in bilateral abductor pollicis brevis (APB). The characteristics of MEP waveform latency, amplitude and motor threshold were described and compared between the healthy control and observation groups; the correlations were analyzed between the MEP latency and the severity of spinal cord injury [American Spinal Injury Association (ASIA) total score and motor function of Upper Extremity Motor Subscores (UEMS)] in the observation group. According to different MEP-induced states, the patients in the observation group were divided into a resting group ( n=19), a facilitation group ( n=18), and a no-waveform group ( n=8). The severity of spinal cord injury (ASIA total score) and the functional independence of the spinal cord (SCIM-Ⅲ score) were compared among the 3 groups to analyze the correlation between the MEP-induced state and the severity of spinal cord injury (ASIA total score). Results:The observation group had a significantly longer MEP latency [(30.16±6.32) ms], a significantly smaller amplitude [(0.54±0.30) mV] and a significantly higher motor threshold [(65%±11%)] than the healthy control group (all P<0.05). The MEP latency in the observation group was significantly correlated with ASIA total score ( r=-0.730, P<0.001) and UEMS ( r=-0.740, P<0.001). The ASIA total score and SCIM-Ⅲ score were significantly different among the 3 groups ( P<0.05), and the MEP-induced state was significantly correlated with the severity of spinal cord injury (ASIA total score) ( r=0.668, P<0.001). Conclusions:In patients with acute cervical hyperextension injury and CCS, the MEP latency is prolonged, the amplitude lowered, and the motor threshold enhanced. The MEP latency is strongly correlated with the severity of spinal cord injury and upper limb motor function. The MEP-induced state is also closely related to the severity of spinal cord injury.
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ABSTRACT Purpose To investigate the effect of ferulic acid (FA) on spinal cord injury (SCI)-induced motor dysfunction and to explore the possible pharmacological mechanisms. Methods Adult male Wistar rats were used in our study. SCI was achieved by clipping the spinal cord T9 of the rat by a vascular clip for 2 minutes. The motor function of the rat was evaluated by Basso, Beattie, and Bresnahan scoring method (BBB) and inclined plane test. Hematoxylin and eosin (HE) staining, NISSL staining, and transmission electron microscopic examination were used to evaluate alterations at the histological level. Polymerase chain reaction (PCR), Western blots, and enzyme-linked immunosorbent assays (ELISA) were employed in biochemical analysis. Results The BBB score and inclined plane test score significantly decreased after SCI surgery, whereas chronic FA treatment (dose of 90 mg/kg, i.g.) for 28 days improved SCI-induced motor dysfunction. HE staining showed that SCI surgery induced internal spinal cord edema, but the structural changes of the spinal cord could be reversed by FA treatment. NISSL staining and transmission electron microscopic examination confirmed the improvement of the effect of FA on the injury site. In the biochemical analysis, it could be found that FA inhibitedSCI-induced mRNA and protein overexpression of pro-inflammatory cytokines (IL-1β, IL-6, TNF-α), as well as iNOS and COX-2 via the modulation of NF-κB level in the spinal cord of SCI rat. Moreover, the SCI-induced decrease of Bcl-2/Bax ratio was also reversed by FA treatment. However, the effect of FA on the expression of Beclin-1 was not statistically significant. Conclusions FA showed a therapeutic effect on SCI, which may be associated with the regulation of neuroinflammation and apoptosis.
Subject(s)
Animals , Male , Rats , Spinal Cord Injuries/drug therapy , Spinal Cord , Rats, Wistar , Rats, Sprague-Dawley , Apoptosis , Coumaric Acids , Recovery of FunctionABSTRACT
BACKGROUND: In the treatment of central cord syndrome, it is difficult to predict the degree of nerve recovery because of the different speeds and degrees of nerve recovery. The treatment of central cord syndrome, especially the treatment methods, is still controversial. OBJECTIVE: To investigate the factors influencing the prognosis of central cord syndrome treated with drug therapy and titanium plate fixation. METHODS: A retrospective analysis of 243 patients with central cord syndrome who were admitted to Changzhou Second People’s Hospital Affiliated to Nanjing Medical University from June 2012 to June 2017 was performed. According to therapeutic schedule, the patients were divided into two groups. In the titanium plate group, 152 cases were treated with titanium plate fixation, and 91 cases in the drug treatment group were treated with drugs. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Neurological function was assessed using American Spinal Injury Association and Japanese Orthopedic Association criteria. American Spinal Injury Association and Japanese Orthopedic Association scores were recorded for all patients within 24 hours of treatment, 6, 12, and 24 months after treatment. The age, treatment, and gender factors were included in the prognostic single factor analysis at 6 and 24 months after treatment of cervical spinal cord syndrome. After that, age, treatment and gender factors were included in the multivariate logistic regression analysis of prognosis at 6 and 24 months after treatment of cervical spinal cord syndrome. RESULTS AND CONCLUSION: (1) 243 patients were followed up for at least 24 months and recovered well after treatment. (2) American Spinal Injury Association and Japanese Orthopedic Association scores were lower in the drug treatment group than in the titanium plate group at 6 months after treatment (P=0.001 2, 0.000 0). However, American Spinal Injury Association and Japanese Orthopedic Association scores were higher in the drug treatment group than in the titanium plate group at 24 months after treatment (P=0.037 4, 0.047 8). (3) The prognosis of central cord syndrome after 6 months of treatment was related to the age and treatment of the patients (P=0.007 2, P < 0.000 1). Moreover, drug treatment and age greater than 50 years were associated with poor prognosis in patients with central cord syndrome at 6 months after treatment (P=0.043, P=0.010). (4) The prognosis at the 24-month follow-up of central cord syndrome was correlated with the patient’s treatment (P=0.004 3). Moreover, the drug treatment was associated with prognosis at the 24-month follow-up of central cord syndrome (P=0.021). (5) Results indicated that at the time of titanium plate fixation, the recovery rate was faster in 6 months than that of drug treatment. However, at 24 months follow-up after treatment, the recovery effect of drug treatment was better than that of titanium plate fixation. At 6 months after treatment, the prognosis was related to the treatment mode and age, but at 24 months after treatment, the prognosis was related to the treatment mode.
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OBJECTIVE: To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on neurological and functional recovery in patients with central cord syndrome (CCS) involving the upper extremities between the treated and non-treated sides of the treated group and whether the outcomes are comparable to that of the untreated control group. METHODS: Nineteen CCS patients were treated with high-frequency (20 Hz) rTMS over the motor cortex for 5 days. The stimulation side was randomly selected, and all the subjects received conventional occupational therapy during the rTMS-treatment period. Twenty CCS patients who did not receive rTMS were considered as controls. Clinical assessments, including those by the International Standard for Neurological Classification of Spinal Cord Injury, the Jebsen-Taylor Hand Function Test, and the O'Connor Finger Dexterity Test were performed initially and followed up for 1 month after rTMS treatment or 5 weeks after initial assessments. RESULTS: The motor scores for upper extremities were increased and the number of improved cases was greater for the treated side in rTMS-treated patients than for the non-treated side in rTMS-treated patients or controls. The improved cases for writing time and score measured on the Jebsen-Taylor Hand Function Test were also significantly greater in number on the rTMS-treated side compared with the non-treated side and controls. There were no adverse effects during rTMS therapy or the follow-up period. CONCLUSION: The results of the application of high-frequency rTMS treatment to CCS patients suggest that rTMS can enhance the motor recovery and functional fine motor task performance of the upper extremities in such individuals.
Subject(s)
Humans , Central Cord Syndrome , Classification , Fingers , Follow-Up Studies , Hand , Motor Cortex , Occupational Therapy , Spinal Cord Injuries , Task Performance and Analysis , Transcranial Magnetic Stimulation , Upper Extremity , WritingABSTRACT
No abstract available.
Subject(s)
Central Cord Syndrome , Spinal Cord Diseases , Spinal Cord IschemiaABSTRACT
Acute traumatic central cord syndrome ( ATCCS) is the most common incomplete cervical spinal cord injury .Its di-agnosis mainly depends on the mechanism of injury , physical signs and imaging examination .The main treatment method is conserva-tion or surgery.Here we reviews the progress of its pathogenesis , pathophysiological changes , and surgical treatment advances .
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Recognizing the importance of SCIWORA in adult age; analyze the usefulness of complementary studies; evaluating therapeutic options; learn about the evolution of the treated patients. A prospective evaluation with a minimum follow-up of 5 years, eight elderly patients with cervical arthrosis and diagnosis of SCIWORA. The Japanese Orthopaedic Association (JOA) scale and ASIA were used on admission and at 6, 12, 24, 36, 48 and 60 months. The central cord syndrome (CCS) was the neurological condition at admission. One patient recovered after corticosteroid therapy, but later, his disability worsened, and he was operated at 18 months, another patient recovered and a third died. The other patients underwent laminoplasty in the first 72 hours; patients with partial severity condition had a minimum improvement of five points in JAO scale and those with severe conditions died. The low-energy trauma can decompensate the relationship between container and content in the spine with asymptomatic arthrosis, and can be devastating to the patient. The diagnosis of intramedullary lesion is made by magnetic resonance imaging. Patients with incomplete deficit undergoing laminoplasty reached at least one level in ASIA score. The potential postoperative complications can be serious.
Reconhecer a importância de SCIWORA na idade adulta; analisar a utilidade dos estudos complementares; avaliar as opções terapêuticas; conhecer a evolução dos pacientes tratados. Foi realizada uma avaliação prospectiva com acompanhamento mínimo de 5 anos em oito pacientes idosos com artrose cervical e diagnóstico de SCIWORA. Foram usados a escala da Associação Japonesa de Ortopedia (JOA) e o escore da ASIA à internação e aos 6, 12, 24, 36, 48 e 60 meses. A síndrome medular central (SMC) foi o quadro neurológico à internação. Um paciente recuperou-se depois de corticoterapia, mas a incapacidade piorou posteriormente, sendo operado aos 18 meses; outro atingiu a recuperação e outro morreu. Os outros pacientes foram submetidos à laminoplastia nas primeiras 72 horas; os que tinham gravidade parcial tiveram melhora mínima de cinco pontos na escala da JAO os que tinham afecção mais grave morreram. O trauma de baixo impacto pode desequilibrar a relação entre o continente e o conteúdo na coluna vertebral com artrose, podendo ser devastador para o paciente. O diagnóstico de lesão intramedular é realizado por ressonância magnética. Os pacientes com déficit incompleto tratados com laminoplastia atingiram pelo menos um nível na escala ASIA. As possíveis complicações pós-operatórias podem ser graves.
Reconocer la importancia de SCIWORA en la edad adulta; analizar la utilidad de los estudios complementarios; evaluar las opciones terapéuticas; conocer la evolución de los pacientes tratados. Se realiza una evaluación prospectiva con un seguimiento mínimo de 5 años, de ocho pacientes mayores con artrosis cervical y diagnóstico de SCIWORA. Se utilizaron la Escala de la Asociación de Ortopedia Japonesa (JOA) y ASIA al ingreso, 6, 12, 24, 36, 48 y 60 meses. El síndrome medular central (SMC) fue el cuadro neurológico de ingreso. Un paciente recupero luego de la corticoterapia, posteriormente, empeoró su discapacidad, siendo operado a los 18 meses, otro recupero y otro falleció. Al resto se les realizó laminoplastia en las primeras 72 horas; los cuadros de severidad parcial tuvieron una mejoría mínima de cinco puntos en escala JAO y los cuadros severos fallecieron. Un trauma de baja energía puede descompensar la relación continente contenido en columnas artrósicas asintomáticas, pudiendo ser devastador para el paciente. La resonancia magnética hace diagnóstico de lesión intramedular. Los pacientes con déficit incompleto, tratados con laminoplastia ganaron por lo menos un nivel de ASIA. Las posibles complicaciones post operatorias pueden ser graves.
Subject(s)
Humans , Spinal Cord Injuries , Magnetic Resonance Spectroscopy , Central Cord Syndrome , Osteoarthritis, SpineABSTRACT
PURPOSE: The purpose of this study was to determine the direction for treatment and to evaluate factors influencing improvement by comparison of neurologic and functional outcomes of surgical treatment and conservative treatment for traumatic central cord syndrome. MATERIALS AND METHODS: A total of 28 patients, who were available for follow-up for at least more than one year from January 2005 to December 2008, who were diagnosed as traumatic central cord syndrome were analyzed retrospectively. Fifteen patients underwent surgical treatment (group 1), and 13 patients received conservative treatment (group 2). Maximum canal compromise (MCC), and maximum spinal cord compression (MSCC) were used for radiologic assessment, and American Spinal Injury Association (ASIA) motor score, Japanese Orthopaedic Association (JOA) score, and neck disability index (NDI) were used for assessment of functional outcomes. RESULTS: The mean MCC was 47.2%, mean MSCC was 20.0%, and mean ASIA motor scale was 92.0 (group 1: 92.9, group 2: 90.9) at the final follow-up. The mean JOA score was 12.8 (group 1: 14.0, group 2: 11.4) and mean NDI was 25.0 (group 1: 25.7, group 2: 24.3) at the final follow-up. CONCLUSION: It is concluded that if a patient with traumatic central cord syndrome is young, with a high energy injury combined with fractures, and has severe spinal compression and mild initial neurologic defect, early surgical treatment would be needed as soon as possible.
Subject(s)
Humans , Asia , Asian People , Central Cord Syndrome , Follow-Up Studies , Neck , Retrospective Studies , Spinal Cord Compression , Spinal Cord Injuries , Spinal Injuries , Treatment OutcomeABSTRACT
OBJETIVOS: Analizar cinemática, reconocer cuadro clínico de presentación, describir imágenes, considerar posibilidades terapéuticas y evaluar evolución. MÉTODO: Se analizan 13 pacientes del sexo masculino que presentaron SCIWORA (en inglés Spinal cord injury without radiographic abnormality) entre el 2005 al 2012. Se evalúan cuadro clínico, tratamiento, complicaciones y evolución. RESULTADOS: 10 pacientes mayores de 45 años presentaban signos de espondiloartrosis con mínimos síntomas. De los tres menores de esta edad solo uno presentaba estenosis de canal constitucional asintomática. Todos sufrieron trauma de baja energía. En la resonancia magnética prevaleció el hematoma intramedular y clínicamente todos los pacientes presentaban un síndrome medular central, con cuadro severo (ASIA A-B) en los mayores de 45 años. Siete pacientes fueron tratados inicialmente en forma conservadora; un paciente empeoró y tuvo que ser sometido a intervención quirúrgica 18 meses después y otro falleció en las primeras horas, el resto de los pacientes tuvieron buena evolución. Seis pacientes requirieron cirugía (laminoplastía) en los primeros 10 días; tres fallecieron y el resto mejoro por lo menos un nivel ASIA. CONCLUSIONES: La menor edad, los cuadros leves y el edema intramedular son factores de buen pronóstico y se ven favorecidos con el tratamiento conservador. La mayor edad, la espondiloartrosis y los cuadros severos o progresivos, son factores de mal pronóstico y puede ser necesario su tratamiento quirúrgico.
OBJETIVOS: Análise cinemática, reconhecer apresentação clínica, descrever imagens, considerar as possibilidades terapêuticas e avaliar a evolução. MÉTODO: Análise de 13 pacientes do sexo masculino com SCIWORA (em ingles Spinal cord injury without radiographic abnormality) entre 2005 e 2012. Avalia-se quadro clínico, tratamento, complicações e resultado. RESULTADOS: Dez pacientes com mais de 45 anos apresentaram sinais de espondiloartrose com sintomas mínimos. Dos três pacientes com menos de 45 anos, apenas um tinha estenose de canal constitucional assintomática. Todos haviam sofrido trauma de baixa energia. Na ressonância magnética prevaleceu hematoma intramedular e clinicamente todos os pacientes com mais de 45 anos tinham síndrome medular central grave (ASIA A-B). Sete pacientes foram inicialmente tratados de forma conservadora; um paciente piorou e teve que ser submetido a cirurgia 18 meses depois e outro morreu nas primeiras horas, o restante teve bom desempenho. Seis pacientes necessitaram de cirurgia (laminoplastia) nos primeiros 10 dias; três morreram e os pacientes restantes melhoraram pelo menos um nível ASIA. CONCLUSÕES: A idade mais baixa, os casos não graves e o edema intramedular são bons fatores prognósticos e são favorecidos pelo tratamento conservador. A idade mais elevada, a espondiloartrose e os quadros graves ou progressivos, são fatores de mau prognóstico e podem necessitar de tratamento cirúrgico.
OBJECTIVES: Kinematic analysis, recognize the clinical presentation, describe image tests, consider therapeutic possibilities and assess progress. METHOD: Analysis of 13 male patients with SCIWORA (Spinal cord injury without radiographic abnormality) between 2005 and 2012. Evaluates clinical presentation, treatment, complications and outcome. RESULTS: 10 patients over 45 years showed signs of spondyloarthritis with minimal symptoms. Of the three with less than 45 years, only one had a constitutional asymptomatic stenosis. All had suffered low-energy trauma. In the magnetic resonance prevailed intramedullary haematoma and clinically all patients over 45 years had a central cord syndrome with severe symptoms (ASIA A-B). Seven patients were initially treated conservatively; one patient worsened and had to undergo surgery after 18 months and another died in the early hours; the remaining patients had good performance. Six patients required surgery (laminoplasty) in the first 10 days; three died and the remaining patients improved at least one ASIA level. CONCLUSIONS: The lower age, the mild cases and intramedullary edema are good prognostic factors and are favored by conservative treatment. The higher age, spondyloarthritis and severe or progressive conditions are factors of poor prognosis and may require surgical treatment.
Subject(s)
Humans , Central Cord Syndrome , Spinal Cord Injuries , Diagnostic Imaging , Magnetic Resonance ImagingABSTRACT
Central cord syndrome (CCS) is extremely rare as a direct consequence of generalized epileptic seizure. CCS is associated with hyperextension of the spinal cord and has characteristic radiologic findings including posterior ligamentous injury and prevertebral hyperintensity following magnetic resonance imaging (MRI). We experienced the case of a 25-year-old man who suffered CCS after status epilepticus. Cervical spinal MRI revealed high signal intensity at the C1 level but with no signal or structural changes in other sites. After rehabilitation management, the patient significantly improved on the ASIA (American Spinal Injury Association) motor scale and bladder function. We proposed that epilepsy related CCS may be caused by muscle contractions during generalized seizure, which can induce traction injury of the spinal cord or relative narrowing of spinal canal via transient herniated nucleus pulposus or transient subluxation of vertebra. We also suggest CCS without radiologic findings of trauma has good prognosis compared with other CCS.
Subject(s)
Adult , Humans , Asia , Central Cord Syndrome , Epilepsy , Ligaments , Magnetic Resonance Imaging , Muscle Contraction , Prognosis , Seizures , Spinal Canal , Spinal Cord , Spinal Injuries , Spine , Status Epilepticus , Traction , Urinary BladderABSTRACT
OBJECTIVE: The purpose of this study is to compare the clinical outcomes of the patients with acute traumatic central cord syndrome (ATCCS) who were managed between early surgical treatment and conservative treatment. METHODS: Between March 2004 and May 2007, 45 patients with ATCCS were treated. 27 patients were treated surgically and 18 patients were treated conservatively. Early decompressive surgery was performed within 24 hours after the trauma in all surgical patients. All patients were admitted within 8 hours of injury and high-dose methylprednisolone was administered. The clinical and radiological data were collected for each patient. RESULTS: The significant improvement of American Spinal Injury Association (ASIA) score was achieved within the first 6 months of the surgery. There were statistically significant differences (p<0.05) between the surgical and conservatively treated patients at 1, 3 and 6 months follow-ups. However, there were no statistically significant differences of the improvements between two groups at 1 year. The ASIA score improvement had a positive correlation with the age at injury. The patients who were older than 65 years at injury showed statistically lower motor improvement than the patients who were younger than 65 years. The lengths of hospital stay were significantly shorter in patients with surgical treatments (p<0.05) than those in patients without surgery. CONCLUSION: Comparing with conservative treatment, early surgical decompression may be associated with rapid neurologic improvement, early mobilization, and shorter periods of hospitalization.
Subject(s)
Humans , Asia , Central Cord Syndrome , Decompression , Decompression, Surgical , Early Ambulation , Follow-Up Studies , Hospitalization , Length of Stay , Methylprednisolone , Spinal InjuriesABSTRACT
OBJECTIVE: Ossification of the posterior longitudinal ligament (OPLL) is a degenerative disorder of the spine which is related to cervical compressive myelopathy. We studied patients with central cord syndrome (CCS) to explore the implication of OPLL on clinical features and functional outcomes of CCS. METHOD: A retrospective study was conducted on 26 patients with CCS between 1998 and 2003. Demographic characteristics, mechanisms of injury, neurological impairments, main functional outcomes, and complications were identified. Clinical features and outcomes were compared between OPLL and non-OPLL group. RESULTS: Twenty patients with CCS had OPLL (12/17 with traumatic and 8/9 with non-traumatic CCS). The initial ASIA motor score of OPLL and non-OPLL patients was 67.8 and 65.3 and, at discharge, 82.8 and 78.5. There were no significant differences in gait, bladder management, length of stay, discharge disposition, and major complications between OPLL and non-OPLL group. Among OPLL patients, non- traumatic CCS patients showed higher ASIA motor score at discharge and had a tendency of better functional outcome than traumatic CCS patients. CONCLUSION: OPLL was commonly observed in CCS patients. Mechanism of injury rather than the presence of OPLL was a significant determinant of clinical features or functional outcomes of CCS.
Subject(s)
Humans , Asia , Central Cord Syndrome , Gait , Length of Stay , Longitudinal Ligaments , Retrospective Studies , Spinal Cord Compression , Spine , Urinary BladderABSTRACT
OBJECTIVE: The aim of this study was to identify factors influencing the degree of neurological injury, show the natural course of recovery, and evaluate the relationship between degree of neurological injury and functional recovery from traumatic central cord syndrome. METHOD: We reviewed 15 patients retrospectively and investigated their demographic and treatment data. Initial ASIA motor scales and functional recovery at 4 weeks and 8 weeks after injury were analyzed. RESULTS: The age of patients showed significant correlation with degree of neurological injury (r= 0.55145, p<0.05) while mechanism of injury, surgical intervention and gender difference showed no correlation. Only 2 patients (13.3%) ambulated independently at initial period but subsequently 13 patients (86.7%) at 8 weeks. The number of patients who independently voided increased from 2 (13.3%) to 11 (73.3%) during the 8 weeks. Early ASIA motor score differed significantly according to the degree of functional recovery of bladder and ambulation in 4 weeks, 8 weeks after injury (p<0.05). CONCLUSION: Only the age of patients related to the initial neurologic severity. Most patients regained their bladder and ambulatory functions considerably within 8 weeks, and the degree of early neurological injury by ASIA motor scale reflected the degree of functional recovery in 4 and 8 weeks after injury.
Subject(s)
Humans , Asia , Central Cord Syndrome , Intraoperative Complications , Retrospective Studies , Spinal Cord Injuries , Urinary Bladder , Walking , Weights and MeasuresABSTRACT
The following report is a case of central cord syndrome in a seven-year-old girl. There was no history of major trauma except instances of standing on her head. Plain x-rays and CT myelography of the cervical spine revealed no abnormalities. Although she was apneic for 12 days and quadriparetic, the patient recovered and was able to walk on the 24th hospital day. Since central cord syndrome as a result of standing on head is unusual in children with a normal cervical spine, the arthors decided to report the above described case for medical interest.
Subject(s)
Child , Female , Humans , Central Cord Syndrome , Head , Myelography , Spinal Injuries , SpineABSTRACT
Cruciate paralysis, an unusual clinical entity, is "frequently undiagnosed or misunderstood", and can simulate the acute cervical central-cord injury syndrome. This rare injury pattern is characterized by weakness of upper extremities with little or no compromise of lower limb function following trauma to the superior cervical cord. The pattern of injury and clinical findings support selective damage to the corticospinal tract or upper motor neurons subserving upper limb function with the pyramidal decussation. Authors experience a case of curciate paralysis due to type 2 odontoid fracture and atlas dislocation.