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Objective:To investigate the causes, diagnosis, treatment and prognosis of children with spinal cord injury without radiologic abnormality caused by non-severe violence, and to raise the awareness of spinal cord injury in children.Methods:Retrospective analysis was performed on the age of onset, injury mechanism, main clinical symptoms and occurrence time, treatment process and recovery of children with spinal cord injury without radiologic abnormality caused by non-severe violence. The children were admitted to our hospital from August 2015 to September 2020. Abnormal findings in spinal cord MRI in acute stage were analyzed, and long-term prognosis was followed up by telephone. The degree of spinal cord injury was determined according to the criteria established by the American Spinal Cord Injury Association.Results:Of six patients, three boys and three girls, aged from 16 months to 8 years old.Injury mechanism: fall on the bed, a sudden fall in standing position, fall while jumping in sports.All of the symptoms appeared immediately after trauma, such as limb weakness, pain, unable to walk, urination disorders.Treatment process: spinal immobilization, methylprednisolone pulse therapy[20 mg/(kg·d)], alleviat edema and protect the nerve system, necessary symptomatic treatment including urethral catheterization, the use of antibiotics, timely rehabilitation treatment.No fracture or dislocation was found in all six patients by spinal cord radiometric examination, and MRI of spinal cord indicated abnormal signals of thoracic cord or below. The recovery sequence of spinal cord function: urination function recovery, pain from lower limbs relief, lower limbs weakness improvement.By the time of follow-up by telephone, the course of disease was 1 to 5 years. Urine fecal incontinence was found in one patient, and his muscle strength of both lower extremities belong to grade Ⅰ, atrophic changes were found in spinal cord MRI.The remaining five patients were able to walk independently, complained of leg pain during long distance walking, mild varus or valgus, and no obvious abnormality in spinal cord MRI.Conclusion:In daily activities, except bend down in dancing, falling on the sacral tail is easy to cause spinal cord injury without fracture and dislocation in children. The damaged spinal cord function often cannot recover thoroughly, and even cannot recover. It is advisable to identify early, formulate comprehensive treatment measures in time, strive to improve the prognosis.
ABSTRACT
Spinal cord injuries without radiologic abnormality (SCIWORA) refers to the violence caused by spinal cord injury and radiological examination such as X-ray or CT no visible spine fracture and dislocation,abnormal findings,19％ to 34％ of children traumatic spinal cord disease.After SCIWORA occurs,there was no fever or low heat,and the progress period was short,and the disease of the spinal cord was more than normal,and the disease was less subjective.It should be identified with acute myelitis and other diseases.To improve pediatrician's understanding of SCIWORA,this review summarizes the etiology,clinical characteristics and imaging manifestations of SCIWORA in children in recent 10 years.
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PURPOSE: We wanted to arthroscopically analyze the femoral osseous abnormalities (bumps) in hips with anterior femoroacetabular impingement (FAI) and the other radiologic abnormalities of the hip joint associated with this. MATERIALS AND METHODS: We retrospectively reviewed the radiographs of 45 patients (51 hips) who underwent arthroscopic treatment under the impression of FAI from January to August, 2008. The indications for surgery included persistent hip pain, the absence of advanced osteoarthritis, physical examination or MRA findings consistent with an acetabualr labral tear. Preoperative and postoperative plain radiographs (pelvis AP, frog-leg lateral, cross table lateral and the false profile view) were taken. As the occasion demanded, 3D-CT or MRA were performed. RESULTS: For the radiologic findings, a decreased head-neck offset (<8 mm) was seen in 15 hips. Femoral bumps were seen in 26 hips and among them, 11 hips were associated with acetabular retroversion, 5 hips were associated with a prominent acetabular rim and 13 hips were located on the flattening of the neck due to a decreased offset. Pistol grip deformity was found in 21 hips and acetabular retroversion was done in 32 hips. Regarding the secondary changes, spurs on the acetabulum of the femur were found in 14 hips and femoral bony cysts were found in 23 hips. Arthroscopically, all the hips had acetabular degenerative labral tear and the acetabular cartilage was injured in 32 hips (62.7%). Among them, 25 hips underwent acetabular retroversion. CONCLUSION: Femoral osseous abnormalities are seen in various locations and these abnormalities have various shapes. A considerable number were associated with pincer impingement and they could produce a 'kissing lesion' between the acetabulum and femur. Identification of these abnormalities on radiographs aids confirming FAI in hips with symptomatic early osteoarthritis.
Subject(s)
Humans , Acetabulum , Arthroscopy , Cartilage , Congenital Abnormalities , Femoracetabular Impingement , Femur , Hand Strength , Hip , Hip Joint , Neck , Osteoarthritis , Physical Examination , Retrospective StudiesABSTRACT
To investigate the relationship between adolescent sport activity and abnormalities of the lumbar spine on radiography and magnetic resonance imaging (MRI), 237 collegiate athletes (mean age 19.4), representing judo, wrestling, and track, were analyzed from the point of contact or noncontact sports. Radiologic and/or MRI abnormalities of the lumbar spine were found in 68.7% of contact sports athletes (judo and wrestling, n=147), 53.3% of noncontact sports athletes (track, n=90), 69.9% of athletes who have played contact sports over 9 years (C9 athletes, n=83), and 47.1% of atheletes who have done noncontact sports over 9 years (N9 athletes, n=17). Discopathy related abnormalities on radiologic examination were found in 25.3% and 11.8% of C9 and N9 athletes. Disc degeneration on MRI was found in 45.8% and 29.4% of C9 and N9 athletes. Spondylolysis was found in 31.3% of C9, 5.9% of N9, 31.3% of elementary-C (athletes who played contact sports during elementary school, n=96), 32.8% of elementary-L/I (limited contact/impact sports, n=58), and 8.6% of elementary-N athletes (noncontact sports, n=35), respectively. From these results, we concluded that contact sports activity during adolescence induces lumbar spine abnormalities at a higher rate compared to noncontact sports and that spondylolysis is related to contact or limited contact/impact sport activity during elementary school.
ABSTRACT
A retrospective study of 135 injured cervical spine patients who admitted to Soonchunhyang University Hospital between Jan 1, 1989 and May 31, 1994 was conducted. The major results were as follows: 1) The incidence was highest in fourth decade and average age was 39 years old. The ratio of male to female was 3.5:1. 2) Traffic accident(67%) was the most common cause of cervical spine injury, and passenger car accident(55%) was the most frequent cause among them. 3) In 111 patients, 141 cases of radiographic abnormalities were found and vertebral body fracture(57%) was the most common lesion among them. SCIWORA(spinal cord injury without radiographic abnormality) patients were seven. High cervical spine(C1-2) injury was 36 cases (26%) and lower cervical spine(C3-7) injury was 105 cases(74%). The most common involved level of injured vertebrae was C2(23%) followed by C5(22%), C6(20%). The anterior dislocation of body was more common than the posterior one, and C5-6 dislocation was the most common among them. The compressive flexion(40%) and distractive flexion(29%) injuries were more common among types of the lower cervical injuries. 4) The associated injuries were head injury, long bone fracture, chest injury, visceral injury and mutiple contusion & laceration, and head injury was the most common among them. 5) According to Franekel's grade, the rates of neurologic improvement were 23%, 47% and 14% in total cases, operated and non-operated patients respectively. There was statistical significance in the difference between the improvement of Frankel's grade of operated and those of non-operated patients(p<0.02). 6) In 101 patients(75%) conservative treatment was performed. Of 34 patients(25%) were operated, 23 patients were performed anterior approach and 11 were done posterior approach. 7) The common complications were respiratory disorder, bed sore, and urinary tract infection, in order of frequency and the rate of complication was 33%. 8) Mortality rate during hospitalization was 5%, and the common causes were pneumonia and septicemia.
