Forensic identification of cervical spinal cord injury without fracture or dislocation in 25 cases / 法医学杂志

OBJECTIVE@#To explore forensic identification of causality between injury and the consequence in cases of cervical spinal cord injury without fracture or dislocation.@*METHODS@#Twenty-five cases of cervical spinal cord injury without fracture or dislocation were collected. The age, mode of injury, imaging reports, cervical vertebral degeneration, clinical manifestations, diagnosis, treatment and injury consequences were summarized. The causality between injury and its consequence were classified as direct cause, main cause, same cause, minor cause and no cause.@*RESULTS@#Age, mode of injury, cervical vertebral degeneration and spinal stenosis were important factors in the analysis of causality. In the injured younger than 8-year-old trauma was generally the direct cause to the damage. While in other injured, it was needed to analyze the various factors comprehensively.@*CONCLUSION@#Comprehensive analysis of age, mode of injury, cervical vertebral degeneration, spinal stenosis and other factors would contribute to accurate identification of the causality between the injury and the consequences in cases of cervical spinal cord injury without fracture or dislocation.

Prognostic Factors That Affect the Surgical Outcome of the Laminoplasty in Cervical Spondylotic Myelopathy

BACKGROUND: This study examined the prognostic factors that affect the surgical outcome of laminoplasty in cervical spondylotic myelopathy patients by comparative analysis. METHODS: Thirty nine patients, 26 males and 13 females, who were treated with laminoplasty for cervical myelopathy from September 2004 to March 2008 and followed up for 12 months or longer, were enrolled in this study. The mean age of the subjects was 62.4 years (range, 37 to 77 years). The patients' age, number of surgical segments, spinal cord compression ratio, segment number, level, localized marginal pattern of high signal intensity within the spinal cord in the T2 image, preoperative Japanese Orthopaedic Association Scoring System (JOA) score with the recovery ratio were compared respectively. The JOA score was used for an objective assessment of the patients' preoperative and postoperative clinical status. The recovery ratios of surgery were graded using the Hirabayashi equation. Statistical analysis was carried out using Pearson correlation analysis. RESULTS: The patients' JOA score increased from a preoperative score of 11.1 (range, 5 to 16) to a postoperative score of 14.9 (range, 7 to 17). The average recovery ratio was 65.8% (range, 0 to 100%). The number of segments with high signal changes in the T2 image, a localized marginal pattern with high signal change, signal intensity changes in the upper cervical spinal cord were inversely associated with the recovery ratio, whereas the spinal cord compression ratio showed a significant positive correlation. However, the currently known prognostic factors, such as number of surgical segment, age, and preoperative JOA score, showed no statistically significant correlation. CONCLUSIONS: The number of segments, localized marginal pattern, rostral location of signal intensity c hanges with a high signal change in the T2 image and a low spinal cord compression ratio in cervical spondylotic myelopathy patients treated by laminoplasty can indicate a poor prognosis.

study on mechanical low back pain comparison between effects of therapeutic exercises on subacute mechanical low back pain due to herniated lumbar disc and lumbar spondylosis

Low back pain is a socioeconomic problem of tremendous impact, producing major costs, suffering and in a minority of patients chronic disability. Low back pain is one of the most common and costly medical condition in Egypt. It causes periods of absence from work. The aim of this study was to compare effect of strengthening and stretching back exercises in treatment of subacute mechanical low back pain due to herniated lumbar disc and lumbar spondylosis. 24 patients suffering from subacute mechanical low back pain 12 lumbar spondylosis and 12 herniated disc. Comprised the material of this work, both groups receive medical treatment: NSAIDs. Analgesics, muscle relaxant for two months. In addition to medical treatment all patients teached strengthening and stretching exercises for back muscles to be done 3 times per day for two months. The statistical difference In comparing pain grades in herniated disc group and lumbar spondylosis group [Medical treatment andexercises] was not significant [p>0.05] no great difference in grades of pain between the two groups after treatments.-The statistical difference in comparison of improvement in grades of pain in herniated disc group and lumbar spondylosis group was not significant [p>0.05].-Strengthing and stretching exercises of back muscles produce similar improving effect in treatment of cases of subacute mechanical low back pain due to herniated disc and lumbar spondylosis

Anterior cervical interbody fusion using carbon fiber cages

Anterior decompression and inter body fusion is a widely accepted surgical treatment for patients with cervical disc herniations and cervical spondylosis. Tricorticaf iliac crest autograft has been considered the classic method but problems such as graft collapse, and extrusion still persist. Cages were introduced because of their theoretical ability to prevent graft collapse. Carbon fiber cages for anterior cervical fusion will be evaluated in this study. Thirty two patients with symptomatic cervical disc disease were treated by anterior cervical discectomy and fusion using carbon fiber cages packed with autogenous bone graft. The average duration of symptoms was 9.3 months [range, 2-15 months]. The average follow-up was 28 months [range, 12-36 months]. All patients had neck pain. Twenty one patients [65.6%] had a single level affection, and eleven patients [34.4%] had double level affection with a total of 43 disc lesions. Fifteen patients [46.9%] had radiculopathy without myelopathy, ten patients [31.2%] had myelopathy without radiculopathy and seven patients [21.9%] had myeloradiculopathy. Four patients [12.5%] had sphinctric disturbances. Twenty seven patients [84.4%] had complete relief of neck pain. All patients improved neurologically postoperatively, except 2 patients [6.2%] with myelopathy although their symptoms stopped to progress. Maintenance of cervical lordosis or correction of kyphosis occurred in 29 patients [90.6%]. Fusion occurred in 40 disc lesions [93%]. Subsidence [< 5mm] occurred in 6 disc spaces [14%]. There were no implantrelated complications. Carbon fiber cages represent a good option to restore the intervertebral disc space and promote fusion in cervical disc surgery. Furthermore, the bone fusion can be easily assessed because of radiolucency of these cages