Early complications of surgical treatment of cervical spondylotic myelopathy / Complicações precoces do tratamento cirúrgico de mielopatia cervical espondilótica

ABSTRACT Objective: To evaluate the early postoperative complications associated with the surgical approach of the cervical spine of patients with cervical spondylotic myelopathy (CSM), comparing the anterior surgical, the posterior surgical, and the combined approaches. Methods: This is a retrospective study based on a database with 169 patients. Demographic data, such as gender and age, and surgical data, such as surgical approach, number of segments with arthrodesis, surgical time, and complications, were evaluated. Complications were divided into major (deep surgical wound infection, intercurrence with the implant, early new compression, and heart failure) and minor (dysphagia, superficial infection, pain, urinary intercurrence, neuropraxia of the C5 root, acute confusional state, and surgical wound hematoma). Results: This included 169 patients, 57 women (33.7%) and 112 men (66.2%). Age ranged from 21 to 87 years, with a mean of 56.48 (± 11) years. Of these, 52 (30.8%) underwent the anterior approach; 111 (65.7%), the posterior approach; and 6 (3.5%), the combined approach. Conclusion: As in the literature, we evinced dysphagia, pain, and superficial infection of the surgical wound as the most frequent postoperative complications. However, it was impossible to establish a statistical relationship between the incidence of complications and surgical time, access route, and number of fixed segments. Level of Evidence III, Retrospective Comparative Study.

RESUMO Objetivo: Avaliar as complicações pós-operatórias precoces associadas à abordagem cirúrgica da coluna cervical de pacientes portadores de mielopatia cervical espondilótica (MCE), comparando a abordagem cirúrgica anterior, a abordagem cirúrgica posterior e a abordagem combinada. Métodos: Estudo retrospectivo baseado em um banco de dados com 169 pacientes. Foram avaliados dados demográficos, como gênero e idade, e dados cirúrgicos, como abordagem cirúrgica realizada, número de segmentos artrodesados, tempo cirúrgico e complicações. As complicações foram divididas em maiores (infecção profunda da ferida operatória, intercorrência com o implante, nova compressão precoce, insuficiência cardíaca) e menores (disfagia, infecção superficial, dor, intercorrência urinária, neuropraxia da raiz de C5, estado confusional agudo, hematoma de ferida operatória). Resultados: Foram incluídos 169 pacientes, sendo 57 do sexo feminino (33,7%) e 112 do masculino (66,2%). A idade variou de 21 a 87 anos, com média de 56,48 anos (± 11). Destes, 52 (30,8%) foram submetidos à abordagem anterior, 111 (65,7%) à abordagem posterior e 6 (3,5%) à abordagem combinada. Conclusão: Assim como na literatura, evidenciamos a disfagia, a dor e a infecção superficial da ferida operatória como as complicações pós-operatórias mais frequentes. No entanto, não foi possível estabelecer uma relação estatística da incidência de complicações com o tempo cirúrgico, a via de acesso e o número de segmentos fixados. Nível de Evidência III, Estudo Retrospectivo Comparativo.

Relationship between cervical spinal cord morphometry and clinical disability in patients with multiple sclerosis

SUMMARY OBJECTIVE: Multiple sclerosis is an autoimmune disease that commonly affects the cervical part of the spinal cord. The aim of this study was to evaluate the relationship between cervical spinal cord atrophy and clinical disability in multiple sclerosis patients. METHODS: We examined the cervical spinal cord area measurements of 64 multiple sclerosis patients and 64 healthy control groups over the images obtained by a T2-weighted magnetic resonance imaging device. RESULTS: The C2-3, C3-4, C4-5, and C6-7 axial cross-sectional surface area values of the patient group were statistically lower than those of the control group (p<0.05). A negative correlation was found between patients' Expanded Disability Status Scale scores and C4-5, C5-6, and C6-7 axial area (axial area p<0.05; r1=-0.472, r2=-0.513, and r3=-0.415). CONCLUSION: When all parameters were evaluated, the data of our control group were found to be higher than the multiple sclerosis groups. There appears to be a significant relationship between patients with cervical spinal cord atrophy and an increase in Expanded Disability Status Scale scores.

Effects of the combination of acupuncture and medication on orthostatic hypotension after incomplete cervical spinal cord injury / 针灸推拿医学（英文版）

Objective: To observe the effect of the combination of acupuncture and medication on orthostatic hypotension after incomplete cervical spinal cord injury. Methods: Ninety-two patients with orthostatic hypotension after incomplete cervical spinal cord injury were divided into two groups according to the random number table method, with 46 cases in each group. The control group was treated with oral midodrine hydrochloride on the basis of conventional treatment, and the observation group was treated with acupuncture in addition to the intervention used in the control group. Both groups were treated for 4 weeks. The changes in supine and orthostatic blood pressures, motor and sensory scores, quadriplegic function index score, clinical efficacy, and safety evaluation were observed. Results: During the treatment, 2 cases dropped out in the observation group, and 3 cases dropped out in the control group. After 4 weeks of treatment, the clinical efficacy of the observation group was better than that of the control group (P<0.05). After treatment, the supine systolic blood pressure and diastolic blood pressure in the two groups had no significant changes (P>0.05), while the orthostatic systolic blood pressure and diastolic blood pressure, the motor and sensory scores, and the quadriplegic function index score were significantly higher than those before treatment (P<0.05), and the scores in the observation group were higher than those in the control group (P<0.05). Adverse reactions were mild in both groups. Conclusion: The combination of acupuncture and medication can significantly improve the orthostatic blood pressure, motor and sensory function and daily living ability of patients with orthostatic hypotension after incomplete cervical spinal cord injury, and it is safe and reliable.

Presentación de caso / Spinal cord reperfusion injury secondary to intradural cervical hernia surgery. A case report

RESUMEN La hernia discal intradural es una condición rara. Los déficits neurológicos posquirúrgicos son complicaciones muy poco frecuentes. La aparición de hiperintensidad medular en la imagen de resonancia magnética posoperatoria, en un paciente con una cirugía sin complicaciones sugiere el diagnóstico de White Cord Syndrome o lesión por reperfusión de la médula espinal. En este artículo se describen las características de una paciente que desarrolló defecto neurológico severo posoperatorio. Con cirugía cervical previa, presentó hernia discal extruida C6-C7 que comprimía el cordón medular. Se realizó disectomía, y se presentó entonces déficit neurológico posoperatorio; otros hallazgos clínicos e imagenológicos llevaron a la reintervención quirúrgica. Al cabo de dos meses presentaba Nurick 5. El White Cord Syndrome resulta una complicación poco frecuente; tanto así que este caso es el primero reportado en Cuba. Su presentación luego de cirugía para un disco intradural no ha sido referida. Se diagnostica por la exclusión de complicaciones transoperatorias, y por hiperintensidad del cordón medular en T2. La fisiopatología está mediada por radicales libres. El manejo se centra en una adecuada descompresión, uso de esteroides y rehabilitación. La identificación precoz de este síndrome es crucial para evitar complicaciones fatales.

ABSTRACT Intradural disc herniation is a rare condition. Post-surgical neurological deficits are very rare complications. The appearance of spinal cord hyperintensity on postoperative magnetic resonance imaging in a patient with uncomplicated surgery suggests a diagnosis of White Cord Syndrome or spinal cord reperfusion injury. This article describes the characteristics of a patient who developed a severe postoperative neurological defect. With previous cervical surgery, presented extruded C6-C7 disc herniation that compressed the spinal cord. Discectomy was performed, and postoperative neurological deficit was then presented; Other clinical and imaging findings led to surgical reintervention. Two months later, she presented Nurick 5. White Cord Syndrome is a rare complication; so much so that this case is the first reported in Cuba. The presentation after surgery for an intradural disc has not been reported. It is diagnosed by the exclusion of intraoperative complications, and by hyperintensity of the spinal cord in T2. The pathophysiology is mediated by free radicals. Management focuses on adequate decompression, steroid use, and rehabilitation. Early identification of this syndrome is crucial to avoid fatal complications.

Surgical timing for acute traumatic central cord syndrome / 中华创伤骨科杂志

Objective:To investigate the effects of different surgical time points on the treatment efficacy of acute traumatic central cord syndrome (ATCCS).Methods:Retrospectively analyzed were the 84 ATCCS patients who had been treated at Department of Spinal Surgery, Henan Provincial People's Hospital from January 2013 to February 2021. According to the surgical timing, the patients were divided into 3 groups. In group A (surgery < 48 hours) of 16 cases, there were 11 males and 5 females, aged from 43 to 76 years; in group B (surgery within 3 to 7 days) of 41 cases, there were 31 males and 10 females, aged from 41 to 78 years; in group C (surgery within 8 to 14 days) of 27 cases, there were 15 males and 12 females, aged from 46 to 83 years. Anterior, posterior or combined anterior and posterior approaches were used according to their specific condition. The American Spinal Injury Association (ASIA) motor scores and Japanese Orthopaedic Association (JOA) scores at admission, 7 days and 12 months after operation, postoperative ICU duration, and complications were compared among the 3 groups.Results:There were no significant differences in the preoperative general information or surgical approaches among the 3 groups, showing they were comparable ( P> 0.05). In all patients, the ASIA motor scores and JOA scores at 7 days and 12 months after operation were significantly better than those at admission, and the ASIA motor scores and JOA scores at 12 months after operation were significantly better than those at 7 days after operation ( P<0.01). There was no significant difference in the ASIA motor score or JOA score between the 3 groups at 7 days or 12 months after operation ( P>0.05). The postoperative ICU duration in group A was 42 (26, 61) h, significantly longer than 23 (16, 35) h in group B and 24 (14, 38) h in group C ( P<0.05). There were no deaths in the 84 patients; there was no significant difference in the overall incidence of serious complications or in that of general complications among the 3 groups ( P>0.05). Conclusions:Surgery is safe and effective for ATCCS. However, decompression surgery within 2 weeks may achieve better outcomes.

Síndrome de Brown-Séquard por hernia discal cervical / Brown-Séquard syndrome due to cervical disc herniation

RESUMEN Introducción: El síndrome de Brown-Séquard representa entre el 1 y el 4 % de todas las lesiones medulares espinales; es muy infrecuente. Compromete la mitad lateral de la médula espinal y se afectan unilateralmente las estructuras o funciones del segmento dorsal, el tracto corticoespinal y el tracto espinotalámico. Objetivo: Mostrar una forma de presentación atípica de la hernia discal cervical en una paciente joven sin antecedentes de traumatismo ni esfuerzo físico. Caso clínico: Paciente femenina de 24 años de edad, que presenta disminución de la fuerza muscular en los miembros del lado izquierdo, de forma progresiva, con dificultades para deambular, así como dolor cervical de intensidad moderada. Se le diagnostica una hernia discal cervical y se realiza tratamiento quirúrgico con evolución satisfactoria. Conclusiones: En el síndrome de Brown-Séquard causado por discopatía cervical, el tratamiento oportuno determina de forma esencial el mejoramiento de los síntomas de forma rápida; la fisioterapia y rehabilitación juegan un papel fundamental en la recuperación motora.

ABSTRACT Introduction: Brown-Séquard syndrome accounts for 1 to 4 % of all spinal cord injuries, very infrequent. It involves the lateral half of the spinal cord and the structures and/or functions of the dorsal segment, the corticospinal tract and the spinothalamic tract are unilaterally affected. Objective: To show an atypical presentation of cervical disc herniation in a young female patient with no history of trauma or physical exertion. Clinical case: A 24-year-old female patient presented with a progressive decrease in muscle strength on the left side of the limbs, with difficulty in walking, as well as moderate cervical pain. She was diagnosed with a cervical disc herniation and surgical treatment was performed with satisfactory evolution. Conclusions: In Brown-Séquard Syndrome caused by cervical disc disease, timely treatment is essential for rapid improvement of symptoms; physiotherapy and rehabilitation play a key role in motor recovery.

Efficacy of Surgery and Rehabilitation for Cervical Cord Injury with Concomitant Heterotopic Ossification around the Hip Joint on the Acquisition of Transferable Movements / The Japanese Journal of Rehabilitation Medicine

Heterotopic ossification (HO) is one of the complications of a cervical cord injury that results in limited range of motion, which can interfere with basic movements and activities of daily living. We encountered a case of a cervical cord injury patient with limited range of motion and mobility due to HO of the hip joint who experienced improvement in both as a result of early surgery and rehabilitation. A 17-year-old boy was diagnosed with a cervical cord injury due to an anterior fracture of the sixth cervical vertebrae following a fall into a pool. It was classified as bilateral C6BII according to the Zancolli's classification for cervical cord injury. The patient presented with limited range of motion in his left hip and was diagnosed with HO four months after the injury. Eight months after the injury, his hip range of motion deteriorated further；consequently, he required continuous transfer assistance. Therefore, surgical HO removal was performed during this period of convalescent rehabilitation. The patient underwent constant post-operative rehabilitation, and the range of motion in his left hip joint improved；thus, he became independent in transfer activities. A concomitant HO after a cervical cord injury can lead to functional impairment in convalescent rehabilitation. In addition, no practice guidelines have been developed that include recommendations on when to perform surgical procedures for HO. Treatment of HO with a combination of immediate surgery and aggressive rehabilitation can be expected to restore function and maximize activity and participation in patients with cervical cord injury with concomitant HO.

Efficacy of Surgery and Rehabilitation for Cervical Cord Injury with Concomitant Heterotopic Ossification around the Hip Joint on the Acquisition of Transferable Movements / The Japanese Journal of Rehabilitation Medicine

Heterotopic ossification (HO) is one of the complications of a cervical cord injury that results in limited range of motion, which can interfere with basic movements and activities of daily living. We encountered a case of a cervical cord injury patient with limited range of motion and mobility due to HO of the hip joint who experienced improvement in both as a result of early surgery and rehabilitation. A 17-year-old boy was diagnosed with a cervical cord injury due to an anterior fracture of the sixth cervical vertebrae following a fall into a pool. It was classified as bilateral C6BII according to the Zancolli's classification for cervical cord injury. The patient presented with limited range of motion in his left hip and was diagnosed with HO four months after the injury. Eight months after the injury, his hip range of motion deteriorated further；consequently, he required continuous transfer assistance. Therefore, surgical HO removal was performed during this period of convalescent rehabilitation. The patient underwent constant post-operative rehabilitation, and the range of motion in his left hip joint improved；thus, he became independent in transfer activities. A concomitant HO after a cervical cord injury can lead to functional impairment in convalescent rehabilitation. In addition, no practice guidelines have been developed that include recommendations on when to perform surgical procedures for HO. Treatment of HO with a combination of immediate surgery and aggressive rehabilitation can be expected to restore function and maximize activity and participation in patients with cervical cord injury with concomitant HO.

Aspectos neuroquirúrgicos de las mucopolisacaridosis / Neurosurgical aspects of mucopolysaccharidoses

Mucopolisacaridosis es una rara enfermedad que afecta al metabolismo de los mucopolisacaridos debida a la ausencia o deficiencia de las enzimas encargadas de su síntesis lo que produce depósitos de aminoglucósidos en casi todos los tejidos del organismo. De acuerdo a la enzima faltante se clasifican los distintos tipos de la enfermedad, siendo más frecuente el Tipo I con sus tres variantes: Hurler, Hurler-Sheie y Sheie de distinta gravedad y tratamiento. Al nacimiento el niño no presenta síntomas, éstos van apareciendo a partir del año de vida: retardo físico y mental, múltiples deformidades esqueléticas, hepatoesplenomegalia, sordera, opacidades corneanas, entre otras. La intervención neuroquirúrgica en esta entidad es en dos patologías: la hidrocefalia, que al no presentar los signos clásicos de hipertensión endocraneana puede ser confundida con atrofia y la compresión medular cervical por los depósitos de mucopolisacáridos en vértebras, ligamentos y leptomeninges.

Mucopolysaccharidosis is a rare illness that involves the metabolism of mucopolysaccharides, that due to the absence or deficiency of corresponding enzymes, accumulate in almost all the tissues of the body. According to which enzyme is missing, different types of the disease have been identified; the most frequent being Type I with its three variants: Hurler, Hurler-Sheie, and Sheie. Symptoms of this disorder progress and range from mental and physical retardation, multiple skeletal deformities, hepatosplenomegaly, deafness, and corneal opacities among others. Children affected usually appear normal at birth and the slowness in their development may be the first evidence of the disorder whose progression is downhill. Neurosurgical intervention occurs in two pathologies: hydrocephalus that does not show signs of intracranial hypertension and can be confused with atrophy, and cervical cord compression due to storage of mucopolysaccharides in vertebrae, ligaments, and leptomeninges.

Vertebral artery occlusion with lateral medullary syndrome and cervical cord infarct

@#Wallenberg syndrome (lateral medullary syndrome) is a type of posterior circulation stroke resulting in brainstem infarction which is most often caused by occlusion of vertebral artery or posterior inferior cerebellar artery or both.1 Here we report a case of right lateral medullary syndrome secondary to vertebral artery occlusion with associated left cerebellar and cervical cord infarct resulting in quadriparesis.

Evaluation of patients with subaxial cervical fractures by the new aospine classification / Avaliação de pacientes com fratura cervical subaxial por meio da nova classificação aospine / Evaluación de pacientes con fractura cervical subaxial por medio de la nueva clasificación aospine

ABSTRACT Objective: To evaluate the profile of patients with fracture and / or dislocation of the subaxial cervical spine using the new AOSpine classification and to correlate it with the trauma mechanism and the type of neurological deficit. Methods: Analyses were performed of the medical records of patients admitted to a tertiary hospital with fracture and / or subaxial cervical dislocation during the period from 2009 to 2016. For the evaluation of the association between the two categorical variables, the Chi-square test was used with a significance level of p <0.05. Results: A total of 67 medical records were analyzed, in which a higher prevalence of type C fractures (49.3%) was observed. The neurological subclassification N4 (35.8%) was the most prevalent type found, followed by subtype N0 (26.9%). Among the main injury mechanisms found, the most prevalent was the motorcycle accident (29.9%). There was no statistically significant association between the injury mechanism and the AOSpine morphological classification (p> 0.05) or neurological deficit (p> 0.05). Conclusion: Cervical fractures of type C, due to automobile accidents were the most prevalent. It was not possible to determine an association between the degree of neurological involvement and the morphology of the injury. Level of Evidence II; Retrospective study.

RESUMO Objetivo: Avaliar o perfil dos pacientes com fratura e/ou luxação da coluna cervical subaxial por meio da nova classificação AOSpine e correlacionar com o mecanismo de trauma e o tipo de déficit neurológico. Métodos: Foram realizadas análises dos prontuários médicos dos pacientes admitidos em um hospital terciário com fratura e/ou luxação cervical subaxial entre o período de 2009 a 2016. Para a avaliação da associação entre as duas variáveis categóricas, utilizou-se o teste Qui-quadrado com nível de significância de p<0,05. Resultados: Foram analisados 67 prontuários, em que se obteve maior prevalência para as fraturas do tipo C (49,3%). A subclassificação neurológica N4 (35,8%) foi o tipo mais prevalente encontrado, seguido pelo subtipo N0 (26,9%). Entre os principais mecanismos de lesão encontrados, o mais prevalente foi o acidente motociclístico (29,9%). Não foi observada associação estatisticamente significativa entre o mecanismo de lesão com a classificação morfológica AOSpine (p > 0,05) ou com o déficit neurológico (p > 0,05). Conclusão: As fraturas cervicais do tipo C, devido a acidentes automobilísticos, foram as mais prevalentes. Não foi possível obter associação entre o grau de acometimento neurológico e a morfologia da lesão. Nível de evidência II; Estudo Retrospectivo.

RESUMEN Objetivo: Evaluar el perfil de los pacientes con fractura y / o luxación de la columna cervical subaxial por medio de la nueva clasificación AOSpine y correlacionar con el mecanismo de trauma y el tipo de déficit neurológico. Métodos: Se realizaron análisis de los historiales médicos de los pacientes admitidos en un hospital terciario con fractura y/o luxación cervical subaxial entre el período de 2009 a 2016. Para la evaluación de la asociación entre dos variables categóricas, se utilizó el test Chi-cuadrado, con nivel de significancia de p <0,05. Resultados: Se analizaron 67 historiales, en que se obtuvo mayor prevalencia para las fracturas del tipo C (49,3%). La subclasificación neurológica N4 (35,8%) fue el tipo más prevalente encontrado, seguido del subtipo N0 (26,9%). Entre los principales mecanismos de lesión encontrados, el más prevalente fue el accidente motociclístico (29,9%). No se observó asociación estadísticamente significativa entre el mecanismo de lesión con la clasificación morfológica AOSpine (p> 0,05) o con el déficit neurológico (p> 0,05). Conclusión: Las fracturas cervicales del tipo C, debido a accidentes automovilísticos, fueron las más prevalentes. No fue posible obtener asociación entre el grado de afectación neurológica y la morfología de la lesión. Nivel de evidencia II; Estudio retrospectivo.

Schistosomal Cervical Myelopathy

Schistosomiasis is an infectious disease caused by trematode platyhelminths of the genus Schistosoma. The involvement of the cervical spinal cord is rare, with few cases reported in the literature. The management of such patients is particularly challenging, since clinical and radiological findings may be confounded with other inflammatory diseases and/ or spinal cord tumors. We describe a 20-year old male with a history of swimming outdoors. He first presented pain in the back of the neck extending to shoulders and upper limbs paresis associated with four limbs hyperreflexia. The magnetic resonance imaging (MRI) showed a hypointense T1-weighted lesion in the cervical spinal cord, which was hyperintense on T2 images. The serologic testing was negative for schistosomiasis. A cervical cord biopsy at the C5-C6 level showed Schistosoma eggs in the histopathological examination. The treatment was performed using a single dose of praziquantel 50 mg/kg, with prednisone 40 mg/day for 3 weeks. On the follow-up, 1 year later, the patient presented mild reduction of the vibratory sensitivity in the distal third of both legs. Our illustrative case strengthens that, in endemic regions, Schistosoma mansoni infestation should be included in the differential diagnosis of intramedullary expansive lesions.

A esquistossomose é uma doença infecciosa causada por platelmintos trematódeos do gênero Schistosoma. O acometimento da medula espinhal cervical é raro, com poucos casos apresentados na literatura. O manejo desses pacientes é particularmente difícil, uma vez que os achados clínicos e radiológicos podem ser confundidos com outras doenças inflamatórias e/ou tumores da medula espinhal. Descrevemos um homem de 20 anos de idade com história de natação ao ar livre. Primeiramente, ele apresentou cervicalgia que se estendeu até os ombros e paresia dos membros superiores, associada à hiperreflexia de quatro membros. A ressonância magnética (RM) mostrou lesão hipointensa em T1 na medula espinhal cervical, a qual foi hiperintensa nas imagens em T2. O teste sorológico foi negativo para esquistossomose. Uma biópsia da medula cervical ao nível C5-C6 evidenciou ovos de Schistosoma no exame histopatológico. O tratamento foi realizado com dose única de praziquantel 50 mg/ kg, com prednisona 40 mg/dia por 3 semanas. No seguimento de 1 ano, o paciente apresentou discreta redução da sensibilidade vibratória no terço distal de ambas as pernas. Nosso caso ilustrativo reforça que, em regiões endêmicas, a infestação pelo Schistosoma mansoni deve ser incluída no diagnóstico diferencial de lesões expansivas intramedulares.

The Need for Early Tracheostomy in Patients with Traumatic Cervical Cord Injury

BACKGROUND: In patients who need sustained endotracheal intubation and mechanical ventilation due to respiratory failure after traumatic cervical spinal cord injury, tracheostomy can be performed to reduce the duration of mechanical ventilation and respiratory complications. The purpose of this study was to determine criteria and timing of tracheostomy in patients with severe traumatic cervical spinal cord injury accompanied by motor weakness. METHODS: We reviewed 22 patients who underwent tracheostomy (study group) and 27 patients who did not (control group) from January 2005 to March 2016. We assessed the American Spinal Injury Association (ASIA) impairment scale score and investigated accompanying thoracic injury, paradoxical respiration, postoperative endotracheal intubation and other clinical parameters. The study group was also subdivided into the early tracheostomy group and late tracheostomy group depending on whether the tracheostomy was performed within or later than 7 days after surgery. RESULTS: Twenty-two patients in the study group had a mean ASIA impairment scale score of 14.1 points, which was lower than the control group's 23.4 points. Paradoxical respiration was observed in 77% of the patients in the study group compared to 18% in the control group. Postoperative intubation was maintained in 68% in the study group; 32% underwent endotracheal intubation due to respiratory failure within 4 days after surgery and had a tracheostomy. In the control group, postoperative intubation was maintained in 22%, and all of them were weaned off intubation within 4 days after surgery. The duration of intensive care unit hospitalization was 11.4 days for the early tracheostomy group, which was shorter than the late tracheostomy group's 19.7 days. CONCLUSIONS: In patients with severe traumatic cervical spinal cord injury, tracheostomy may be needed when the motor grade of the ASIA scale is low, above the C4 segment is injured, or paradoxical respiration occurs after injuries. In addition, if endotracheal extubation is not feasible within 4 days after surgery, an early tracheostomy should be considered.

Motor and Sensory Function as a Predictor of Respiratory Function Associated With Ventilator Weaning After High Cervical Cord Injury

OBJECTIVE: To analyze the respiratory function of high cervical cord injury according to ventilator dependence and to examine the correlations between diaphragm movement found on fluoroscopy and sensory and motor functions. METHODS: A total of 67 patients with high cervical spinal cord injury (SCI), admitted to our hospital were enrolled in the study. One rehabilitation physician performed sensory and motor examinations on all patients while each patient was in the supine position on the American Spinal Injury Association (ASIA) standard. In addition, fluoroscopic diaphragm movement studies and bedside spirometry were performed. RESULTS: Bedside spirometry and diaphragm fluoroscopic tests were analyzed according to ventilator dependence. Forced vital capacity and maximal inspiratory pressure were significantly higher in the ventilator weaned group. Natural breathing during the fluoroscopic diaphragm examinations and ventilator weaning showed statistical significance with the movement on the right, while deep breathing showed statistical significance with the movement on both sides. Deep breathing movement has correlation with the C5 key muscle. Diaphragm movement has correlation with right C3 and bilateral C4 sensory functions. CONCLUSION: The present expansion study showed that, through simple bedside physical examinations, rehabilitation physicians could relatively easily predict diaphragm movement and respiratory function recovery, which showed significance with ventilator weaning in patients with high cervical SCI.

Localized Girdle Sensation of Mid-Trunk (False Localizing Sign) in a Patient with Compressive Cervical Myelopathy

Patient with compressive cervical myelopathy sometimes present with localized girdle sensation in the mid trunk (called false localizing sign). This symptom often confuses physicians, but the clinical features and mechanism are still unclear. We present a male patient presented with localized girdle sensation in the middle trunk following fall. Later on diagnosis of compressive cervical myelopathy was made after MRI cervical spine

A Comparison of Computed Tomography Measures for Diagnosing Cervical Spinal Stenosis Associated with Myelopathy: A Case-Control Study

STUDY DESIGN: Retrospective comparative study. PURPOSE: To assess differences in computed tomography (CT) imaging parameters between patients with cervical myelopathy and controls. OVERVIEW OF LITERATURE: There is a lack of information regarding the best predictor of symptomatic stenosis based on osseous canal dimensions. We postulate that smaller osseous canal dimensions increase the risk of symptomatic central stenosis. METHODS: CT images and medical records of patients with cervical myelopathy (19 patients, 8 males; average age, 64.4+/-13.4 years) and controls (18 patients, 14 males; average age, 60.4+/-11.0 years) were collected. A new measure called the laminar roof pitch angle (=angle between the lamina) was conducted along with linear measures, ratios and surrogates of canal perimeter and area at each level C2-C7 (222 levels). Receiver-operator curves were used to assess the diagnostic value of each. Rater reliability was assessed for the measures. RESULTS: The medial-lateral (ML) diameter (at mid-pedicle level) and calculated canal area (=anterior-posterior. x ML diameters) were the most accurate and highly reliable. ML diameter below 23.5 mm and calculated canal area below 300 mm2 generated 82% to 84% sensitivity and 67% to 68% sensitivity. No significant correlations were identified between age, height, weight, body mass in dex and gender for each of the CT measures. CONCLUSIONS: CT measures including ML dimensions were most predictive. This study is the first to identify an important role for the ML dimension in cases of slowly progressive compressive myelopathy. A ML reserve may be protective when the canal is progressively compromised in the anterior-posterior dimension.

Airway management of patients with traumatic brain injury/C-spine injury / 대한마취과학회지

Traumatic brain injury (TBI) is usually combined with cervical spine (C-spine) injury. The possibility of C-spine injury is always considered when performing endotracheal intubation in these patients. Rapid sequence intubation is recommended with adequate sedative or analgesics and a muscle relaxant to prevent an increase in intracranial pressure during intubation in TBI patients. Normocapnia and mild hyperoxemia should be maintained to prevent secondary brain injury. The manual-in-line-stabilization (MILS) technique effectively lessens C-spine movement during intubation. However, the MILS technique can reduce mouth opening and lead to a poor laryngoscopic view. The newly introduced video laryngoscope can manage these problems. The AirWay Scope(R) (AWS) and AirTraq laryngoscope decreased the extension movement of C-spines at the occiput-C1 and C2-C4 levels, improving intubation conditions and shortening the time to complete tracheal intubation compared with a direct laryngoscope. The Glidescope(R) also decreased cervical movement in the C2-C5 levels during intubation and improved vocal cord visualization, but a longer duration was required to complete intubation compared with other devices. A lightwand also reduced cervical motion across all segments. A fiberoptic bronchoscope-guided nasal intubation is the best method to reduce cervical movement, but a skilled operator is required. In conclusion, a video laryngoscope assists airway management in TBI patients with C-spine injury.

Comparison of the Using Ability Between a Smartphone and a Conventional Mobile Phone in People With Cervical Cord Injury

OBJECTIVE: To investigate the ability of spinal cord injury (SCI) patients in the use mobile cellular devices, especially the smartphone. METHODS: Seventeen people with motor complete cervical SCI participated in the study. The assist-devices deemed most fitting were introduced to the patients: a mouth stick, multifunctional splint, activities of daily living (ADL) splint, universal cuff or none of the above. To determine the effective devices, a Multi-Directional Click Test (MDCT), Phone Number Test (PNT), and individual satisfaction inquiry were used. The most appropriate assist device was selected by MDCT. Subsequently PNT and individual satisfaction inquiry were performed with the conventional model and compared. RESULTS: Those with C4 cord injury chose mouth stick. Those with C5 cord injury chose multifunctional splint (3 people) and ADL splint (2 people). Those with C6 cord injury chose universal cuff (3 people) or bare hands only. Those with C7 cord injury chose universal cuff (3 people). With a smartphone, all participants were able to complete the PNT. With a conventional model, only twelve participants (71%) were able to complete the same test. While it took 26.8+/-6.8 seconds with a conventional model to complete PNT, the same test took 18.8+/-10.9 seconds to complete with a smartphone (p<0.05). Overall, participants expressed higher satisfaction when using a smartphone. CONCLUSION: The results offer a practical insight into the appropriate assist devices for SCI patients who wish to use mobile cellular devices, particularly smartphones. When the SCI patients are given the use of a smartphone with the appropriate assist devices, the SCI patients are expected to access mobile cellular device faster and with more satisfaction.

Comparison of the Using Ability Between a Smartphone and a Conventional Mobile Phone in People With Cervical Cord Injury

OBJECTIVE: To investigate the ability of spinal cord injury (SCI) patients in the use mobile cellular devices, especially the smartphone. METHODS: Seventeen people with motor complete cervical SCI participated in the study. The assist-devices deemed most fitting were introduced to the patients: a mouth stick, multifunctional splint, activities of daily living (ADL) splint, universal cuff or none of the above. To determine the effective devices, a Multi-Directional Click Test (MDCT), Phone Number Test (PNT), and individual satisfaction inquiry were used. The most appropriate assist device was selected by MDCT. Subsequently PNT and individual satisfaction inquiry were performed with the conventional model and compared. RESULTS: Those with C4 cord injury chose mouth stick. Those with C5 cord injury chose multifunctional splint (3 people) and ADL splint (2 people). Those with C6 cord injury chose universal cuff (3 people) or bare hands only. Those with C7 cord injury chose universal cuff (3 people). With a smartphone, all participants were able to complete the PNT. With a conventional model, only twelve participants (71%) were able to complete the same test. While it took 26.8+/-6.8 seconds with a conventional model to complete PNT, the same test took 18.8+/-10.9 seconds to complete with a smartphone (p<0.05). Overall, participants expressed higher satisfaction when using a smartphone. CONCLUSION: The results offer a practical insight into the appropriate assist devices for SCI patients who wish to use mobile cellular devices, particularly smartphones. When the SCI patients are given the use of a smartphone with the appropriate assist devices, the SCI patients are expected to access mobile cellular device faster and with more satisfaction.

The Selection of the Appropriate Computer Interface Device for Patients With High Cervical Cord Injury

In order to determine the most suitable computer interfaces for patients with high cervical cord injury, we report three cases of applications of special input devices. The first was a 49-year-old patient with neurological level of injury (NLI) C4, American Spinal Injury Association Impairment Scale (ASIA)-A. He could move the cursor by using a webcam-based Camera Mouse. Moreover, clicking the mouse could only be performed by pronation of the forearm on the modified Micro Light Switch. The second case was a 41-year-old patient with NLI C3, ASIA-A. The SmartNav 4AT which responds according to head movements could provide stable performance in clicking and dragging. The third was a 13-year-old patient with NLI C1, ASIA-B. The IntegraMouse enabling clicking and dragging with fine movements of the lips. Selecting the appropriate interface device for patients with high cervical cord injury could be considered an important part of rehabilitation. We expect the standard proposed in this study will be helpful.