RESUMO
Spondyloptosis in the clinic is rarely reported. We herein present a 47-year-old female, who suffered from a crush injury directly by a heavy cylindrical object from the lateral side. She was diagnosed to have traumatic L3 spondyloptosis with multiple traumas. Staged surgical procedures were conducted and a three-year follow-up was obtained. Eventually, normal spinal alignment was restored, and neurological deficits were gradually improved. At three years follow-up, the motor strength scores and function of the sphincters were incompletely improved. Previously published reports on traumatic lumbar spondyloptosis were reviewed and several critical points for management of this severe type of spinal injury were proposed. First, thoracolumbar and lumbosacral junction were mostly predilection sites. Second, numerous patients involving traumatic lumbar spondyloptosis were achieved to American Spinal Injury Association grade A. Third, lumbar spondyloptosis was commonly coupling with cauda equina injury. Finally, the outcomes were still with poorly prognosis and recovery of patients was correlation to spondyloptosis severity. Based on this case report and literatures review, we highlighted that the spinal alignment restoration relying on staged operations and following rehabilitation hereof are both important once facing with multiple traumas. Furthermore, we suggested to perform routine CT angiography during lumbar spondyloptosis to justify whether there are large vessel compression or injury.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Vértebras Lombares/lesões , Espondilolistese/cirurgia , Traumatismos da Coluna Vertebral , Traumatismo Múltiplo/complicaçõesRESUMO
ObjectiveTo explore the application of Brain and Spinal Injury Center (BASIC) score in evaluation of traumatic cervical spinal cord injury. MethodsFrom January, 2015 to December, 2021, 175 patients with traumatic cervical spinal cord injury in Beijing Bo'ai Hospital were analyzed. Gender, age, cause of injury, injury mechanism and American Spinal Injury Association Impairment Scale (AIS) grade were collected. The sagittal and axial T2 weighted imaging (T2WI) of the patients were evaluated with BASIC score, single/multi-segment injury, and with/without intramedullary hemorrhage. According to the injury mechanism, the patients were divided into two groups: with fracture/fracture dislocation (n = 92) and without fracture and dislocation (n = 83). The baseline demographic indicators and T2WI evaluation indicators were compared between the two groups, and the relationship between AIS grade and BASIC score, intramedullary hemorrhage, single/multi-segment injury were investigated. ResultsThere were significant differences in gender, age and AIS grade, BASIC score, and the rates of inntramedullary hemorrhage and single segment injury of T2WI between two groups (t = -10.276, χ2 > 8.703, P < 0.01); however, no difference was found in the cause of injury (P > 0.05). The AIS grade was significantly correlated with the BASIC score (r = 0.790, P < 0.001). There was significant difference in AIS grade between intramedullary hemorrhage or not, and single/multi-segment injury (χ2 > 5.516, P < 0.05). ConclusionThe BASIC score of T2WI is a predictor of the severity of spinal cord injury after traumatic cervical spinal cord injury, and is different with the injury mechanisms.
RESUMO
BACKGROUND: Conventional anterior debridement and bone graft fusion for lumbar spinal tuberculosis have a great trauma, and bring more complications. The double titanium mesh support bone graft combined with posterior pedicle internal fixation reconstruction can significantly improve the prognosis of lumbar spinal tuberculosis. There is no clinical study to compare the efficacy between the two surgical methods. OBJECTIVE: To compare the efficacy of lumbar spinal tuberculosis via anterior double titanium mesh support bone graft combined with posterior pedicle internal fixation and conventional anterior debridement and bone graft fusion. METHODS: Case history data of 40 patients with lumbar spinal tuberculosis were retrospectively collected from the Department of Spinal Surgery, Mianyang Central Hospital, Southwest Medical University from May 2015 to March 2018. The patients were divided into experimental group and control group (n=20) according to the operation. Patients in the experimental group were treated with the anterior double titanium mesh support bone graft combined with the posterior pedicle screw fixation reconstruction. Patients in the control group were treated with anterior debridement and bone graft fusion. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. RESULTS AND CONCLUTION: (1) Lumbar spinal tuberculosis could be effectively treated with both surgical methods. (2) Compared with the control group, the operation time was shorter; the intraoperative blood loss was less; and the bone graft fusion was faster in the experimental group. (3) With prolongation of the postoperative time, the erythrocyte sedimentation rate and the sagittal Cobb angle of the lesion segment gradually decreased in the two groups. The erythrocyte sedimentation rate and the sagittal Cobb angle of the lesion segment in the experimental group were slightly lower than those in the control group. (4) After treatment, the classification of the American Spinal Cord Injury Association was improved in some patients. (5) The incidence of adverse reactions in the experimental group was lower than that of the control group. (6) The results suggest that double titanium mesh support bone graft combined with posterior pedicle internal fixation reconstruction can effectively improve the stability of the diseased vertebrae, and the treatment effect on lumbar spinal tuberculosis is better than conventional anterior lesion removal and bone graft fusion internal fixation.
RESUMO
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.
Assuntos
Humanos , Ásia , Síndrome Medular Central , Descompressão , Descompressão Cirúrgica , Deambulação Precoce , Seguimentos , Hospitalização , Tempo de Internação , Metilprednisolona , Traumatismos da Coluna VertebralRESUMO
The purpose of this study was to evaluate the effectiveness of therapeutic intervention via liaison-psychiatry by a psychiatrist to the team rehabilitation for spinal cord-injured patients with mental disorders. Out of 652 spinal cord-injured patients who underwent rehabilitation during post-acute stages in our hospital from April 2000 to March 2006, 82 patients aged from 19 to 65 with mental disorders according to the diagnostic criteria of DSM-IV-TR were selected. In order to assess the effectiveness of this comprehensive team approach, the outcomes of these 82 patients were compared with the outcomes of 82 control patients without mental disorders. As a result, there were no significant differences of the acquired BI (Barthel Index), FIM (Functional Independence Measure), and abilities of transfer between the two groups. In addition, 35 out of 82 patients went back to their home. These results demonstrate the effectiveness of liaison psychiatry in conducting the comprehensive team rehabilitation for spinal cord-injured patients with mental disorders.