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There is an ongoing controversy about the optimal timing for surgical decompression after acute traumatic cervical spinal cord injury (SCI). For this reason, we performed a retrospective study of patients who were operated on after traumatic cervical SCI at the Trauma Center Murnau, Germany and who met in- as well as exclusion criteria (n = 70 pati...
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PurposeTo identify specific morphological characteristics in thoracolumbar burst fractures associated with neurological outcome after severe traumatic spinal cord injury (TSCI).Methods
We retrospectively analyzed the clinical and radiological (CT scan morphological characteristics) data of 25 consecutive patients admitted for TSCI secondary to a bu...
Spinal Cord is the official journal of the International Spinal Cord Society. It provides complete coverage of all aspects of spinal injury and disease.
To compare and analyze the predictive value of two kinds of classification methods, routine magnetic resonance imaging (MRI) and diffusion tensor tractography (DTT), on the diagnosis and prognosis in different degrees of acute cervical spinal cord injury (ACSCI).
A total of 35 patients with ACSCI treated with surgery in our department from January...
Study design:
Single-subject design, standard training ("B") compared with Robotic training ("C").
Objectives:
To explore the impact of robotic training on upper limb function, activities of daily living (ADL) and training experience in subacute tetraplegic inpatients.
Setting:
Inpatient subacute Norwegian spinal cord injury (SCI) unit.
Metho...
Monoplegia due to spinal cord infarction, spinal epidural anesthesia, and epidural blood patch have been reported. Monoplegia due to cervical cord injuries is rare, and monoplegia of upper extremity is even rarer. The authors present a case of a 33-year-old woman, who fell from a two-storey building and developed monoplegia of right upper extremity...
Citations
... Assessment of function status is one of the important aspects for individuals suffering from SCI, and should be performed at initial evaluation after injury as well as during lifelong follow-up [1]. Thus, it is essential to detect changes of the functional capacity [27] or possible effects of clinical care [14,28]. Besides, monitoring the changes in functional status will also provide better understanding of the recovery after SCI [29]. ...
Spinal Cord Independence Measure (SCIM) was an important functional outcome measure specifically designed for spinal cord injury (SCI) patients, with the self-reported version of SCIM (SCIM-SR) published in 2013. This study aims to translate the SCIM-SR into Chinese, and to investigate the validity of Chinese SCIM-SR among SCI patients. This Chinese version of SCIM-SR was translated into Chinese in a standardized approach, and then filled out by a sample of patients with SCI (n = 205) within 3 days after admission. Validity of Chinese SCIM-SR was then analyzed using Rasch analysis and principal component analysis. The subscale Selfcare and subscale Mobility showed good fit to the Rasch model, with no significance found in Chi-square test results for item-trait interaction, using Bonferroni adjustment for the significant level (χ² =18.125, P = 0.111; χ² =33.629, P = 0.006). Mean fit residual for items and persons of each subscale were within ± 2.5. The model fit of the subscale of Respiration and Sphincter Management was not satisfactory even after deleting one item and merging two items with local dependence. However, Kaiser-Meyer-Olkin test was > 0.50 in total score and all the subscales of Chinese SCIM-SR, and P < 0.05 in the Bartlett’s test. There was no differential item functioning for gender, time post injury, age, and etiology in any of the three subscales. An online version of Chinese SCIM-SR was also developed. It is concluded that the SCIM-SR in Chinese is valid for application in individuals with SCI. SCIM-SR is considered as an important tool for self-reporting functional status from SCI individuals’ perspective.
... En general y por consenso, se ha definido como «descompresión precoz» aquella realizada en las primeras 24 h tras la lesión medular 6 , aunque hay autores que hablan de una mayor efectividad en la descompresión «ultra precoz» dentro de las 8 primeras horas, tiempos muy difíciles de conseguir en la práctica clínica habitual 7,8 . ...
... Timely care in SCI patients has been shown to be important for improving neurologic recovery and outcomes, 10,11 and it is advised that, if possible, surgical decompression be completed in less than 24 h, 12,13 or even just 8 h. 14 This illustrates the need to early and efficient transport of patients with SCI to the proper care facilities. ...
Study design
A retrospective study.
Objectives
The quality of care (QoC) for spinal column/cord injury patients is a major health care concern. This study aimed to implement the QoC assessment tool (QoCAT) in the National Spinal Cord/Column Injury Registry of Iran (NSCIR-IR) to define the current state of pre- and post-hospital QoC of individuals with Traumatic Spinal Column and Spinal Cord Injuries (TSC/SCIs).
Methods
The QoCAT, previously developed by our team to measure the QoC in patients with TSC/SCIs, was implemented in the NSCIR-IR. The pre-hospital QoC was evaluated through a retrospective analysis of NSCIR-IR registry data. Telephone interviews and follow-ups of patients with SCI evaluated the QoC in the post-hospital phase.
Results
In the pre-hospital phase, cervical collars and immobilization were implemented in 46.4% and 48.5% of the cases, respectively. Transport time from the scene to the hospital was documented as <1 hour and <8 hours in 33.4% and 93.9% of the patients, respectively. Post-hospital indicators in patients with SCI revealed a first-year mortality rate of 12.5% (20/160), a high incidence of secondary complications, reduced access to electrical wheelchairs (4.2%) and modified cars (7.7%), and low employment rate (21.4%).
Conclusion
These findings revealed a significant delay in transport time to the first care facilities, low use of immobilization equipment indicating low pre-hospital QoC. Further, the high incidence of secondary complications, low employment rate, and low access to electrical wheelchairs and modified cars indicate lower post-hospital QoC in patients with SCI. These findings imply the need for further planning to improve the QoC for patients with TSC/SCIs.
... 1,2 But the role and timing of surgical intervention with severe injuries still remains disputed. [3][4][5][6][7][8][9] Primary insult to spinal cord caused by compression due to dislocation or burst is irreversible. This injury further leads to progressive and continuous compression leading to hypoperfusion of the injured segment increasing the oedema and cord contusion. ...
... 7,8,12,23 The role of timing of surgery in sub axial cervical spine fracture dislocation has always been controversial, with studies supporting both early and late timing of surgery present in literature, but very few are prospective and randomized. [4][5][6]11,14,21,24,25 In this study, good outcome was reported with incomplete spinal cord injuries while patients with complete cervical injuries had high mortality rate and morbidity, indicating that an aggressive approach while selecting patients with complete injury and patients with physiological unstable parameters for early surgical procedures may not be warranted. [7][8][9]11 Various risk factors have been evaluated with respect to spinal cord injuries like duration of injury, incomplete surgical decompression, length of oedema segment in MRI, injury segment and age. ...
Resumo
Objetivo Avaliar os fatores de risco e os desfechos em indivíduos submetidos ao tratamento cirúrgico de lesões subaxiais da coluna cervical em relação ao momento da cirurgia e aos parâmetros fisiológicos pré-operatórios dos pacientes.
Métodos O estudo incluiu 26 pacientes com fraturas e luxações subaxiais da coluna cervical. Dados demográficos, investigação radiológica apropriada e parâmetros fisiológicos, como frequência respiratória, pressão arterial, frequência cardíaca, pressão parcial de oxigênio (PaO2) e escalas de disfunção da American Spine Injury Association (ASIA), foram documentados. No período pré-operatório, os pacientes foram divididos em dois grupos. O grupo instável (I) continha pacientes com parâmetros fisiológicos anormais e o grupo estável (E) era composto por pacientes com parâmetros fisiológicos dentro da faixa de normalidade. Os pacientes foram ainda subdivididos em grupos de tratamento precoce e tardio de acordo com o momento da cirurgia como Iprecoce, Itardio, Eprecoce e Etardio. Todos os pacientes foram chamados para consultas de acompanhamento em 1, 6 e 12 meses.
Resultados Cinquenta e seis por cento dos pacientes do grupo E apresentaram melhora neurológica em um grau ASIA e desfecho bom independentemente do momento da cirurgia. Os desfechos em pacientes do grupo I com parâmetros fisiológicos instáveis e submetidos à intervenção cirúrgica precoce foram maus.
Conclusão Este estudo conclui que a intervenção cirúrgica precoce em pacientes com instabilidade fisiológica teve forte associação como fator de risco no desfecho final em termos de mortalidade e morbidade. Além disso, não foi possível estabelecer nenhuma associação positiva de melhora em pacientes com estabilidade fisiológica em relação ao momento da cirurgia.
... A recent clinical practice guideline for the management of patients with acute tSCI suggests that early decompressive surgery within 24 h of injury be offered as an option for adult acute tSCI patients regardless of level and severity of injury [80]. Although there is growing evidence supporting early decompression in cervical trauma [78,81,84,85], in the setting of thoracic and thoracolumbar SCI there is still controversy regarding the ideal timing for decompression [95]. A recent meta-analysis did not observe a significant beneficial effect of surgical decompression within 24 h of injury in patients with thoracic and thoracolumbar tSCI [93], whereas a more recent randomized control trial showed that surgical decompression within 24 h of acute traumatic thoracic and thoracolumbar SCI is safe and associated with improved neurological outcomes [82]. ...
... This may influence decisions regarding rehabilitation, such as the best postacute rehabilitation setting, inpatient rehabilitation length of stay, and duration of outpatient programs [6]. The presumably favorable prognosis, as well as the different patient characteristics (older age, pre-existing comorbidities), often lead to exclusion of persons with traumatic CCS from retrospective and prospective studies [42][43][44][45][46][47]. Because our understanding of the pathophysiology of CCS continues to evolve, and the diagnosis of CCS is not consistently indicative of patient characteristics, severity or mechanism of injury, recent reports have recommended that the terminology and definition of CCS be revisited [6,7,48]. ...
Central cord syndrome (CCS) is the most common, yet most controversial, among the different spinal cord injury (SCI) incomplete syndromes. Since its original description in 1954, many variations have been described while maintaining the core characteristic of disproportionate weakness in the upper extremities compared to the lower extremities. Several definitions have been proposed in an attempt to quantify this difference, including a widely accepted criterion of ≥10 motor points in favor of the lower extremities. Nevertheless, recent reports have recommended revisiting the terminology and criteria of CCS as existing definitions do not capture the entire essence of the syndrome. Due to methodological differences, the full extent of CCS is not known, and a large variation in prevalence has been described. This review classifies the different definitions of CCS and describes some inherent limitations, highlighting the need for universal quantifiable criteria.
... Cervical spine injury can have substantial societal impact due to its frequent occurrence in people of working age [1]. The degree of restoration of the functional state, quality of life and social rehabilitation depend on timely diagnosis and appropriate treatment [2,3]. One of the more common cervical injuries is the AO Spine [4] type "B" subaxial cervical spine fracture, which is characterized by disruption of the anterior, middle, and posterior support columns by a distraction/compression mechanism [5]. ...
... Patients' study flowchart. Exclude reason(1): Reason *injury C1-C2 localization; Reason **-Type A subaxial injury; Reason ***-complicated Type B subaxial injury; Reason ****-Type C subaxial injury; Reason *****-multilevel subaxial injury;Exclude reason(2): Reason *-loss of follow-up; Reason **refusal to participate in the study; Reason ***-death unrelated to the operation (in these cases, there were no postoperative complications) ...
Purpose
To evaluate the clinical and radiological results of the operative management of three-column uncomplicated type «B» subaxial injures treated with a one-level cervical corpectomy with an expandable cage.
Methods
This study included 72 patients with a three-column uncomplicated type «B» subaxial injures who met the inclusion criteria, underwent a one-level cervical corpectomy with an expandable cage at one of three neurosurgical departments between 2005 and 2020, and were followed up for clinical and radiological outcomes at a minimum 3-yr follow-up.
Results
There was a decrease in the VAS pain score from an average of 80 mm to 7 mm (p = 0.03); a decrease in the average NDI score from 62 to 14% (p = 0.01); excellent and good outcomes according to Macnab’s scale were 93% (n = 67/72). There was an average change in the cervical lordosis (Cobb method) from −9.10 to −15.40 (p = 0.007), without significant loss of lordosis (p = 0.27). There was no significant degeneration of the adjacent levels by 3 years post-op. The fusion rate, using the Cervical Spine Research Society criteria, was poor: it was 62.5% (n = 45/72), and using the CT criteria, it was 65.3% (n = 47/72). 15.4% patients (n = 11/72) suffered complications. Statistical difference between the fusion and pseudoarthrosis (according to X-ray criteria) subgroups showed that there were no statistically significant differences in the smoking status, diabetes, chronic steroid use, cervical injury level, subtypes of AO type B subaxial injuries and types of expandable cage systems.
Conclusions
One-level cervical corpectomy with an expandable cage, despite a poor fusion rate, can be considered a feasible and relatively safe method for treating three-column uncomplicated subaxial type «B» injures, with the benefit of immediate stability, anatomical reduction, and direct decompression of the spinal cord. While no one in our series had any catastrophic complications, we did note a high complication rate.
... Since 2013, a number of reports have examined the outcomes of various surgical regimes for a range of indications in tSCI. There have been arguments that early decompression is better than delayed surgery: [16][17][18][19] others have suggested that it makes little difference to the neurological outcome. 20,21 Some have advocated a delay in operating on patients with acute traumatic cervical central cord syndrome on the basis that early surgery is associated with an increase in mortality, 22 while exactly the opposite view -that there is no increase in mortality -has also been advanced. ...
... Consideration for ultra-early surgical decompression has been proposed, such as less than eight hours or 12 hours after SCI. [16][17][18] However, these studies are limited by their small sample sizes and should be validated with larger prospective cohorts. ...
Initial treatment of traumatic spinal cord injury remains as controversial in 2023 as it was in the early 19th century, when Sir Astley Cooper and Sir Charles Bell debated the merits or otherwise of surgery to relieve cord compression. There has been a lack of high-class evidence for early surgery, despite which expeditious intervention has become the surgical norm. This evidence deficit has been progressively addressed in the last decade and more modern statistical methods have been used to clarify some of the issues, which is demonstrated by the results of the SCI-POEM trial. However, there has never been a properly conducted trial of surgery versus active conservative care. As a result, it is still not known whether early surgery or active physiological management of the unstable injured spinal cord offers the better chance for recovery. Surgeons who care for patients with traumatic spinal cord injuries in the acute setting should be aware of the arguments on all sides of the debate, a summary of which this annotation presents.
Cite this article: Bone Joint J 2023;105-B(4):347–355.
... In our institution, it is the standard that dislocations and dislocation fractures in particular should be reduced as quickly as possible, regardless of the neurological findings [31] . A study by Grassner et al. showed evidence that early surgical decompression after a cervical vertebral fracture has a positive impact on the functional and neurological outcome of treatment [32] . In a study by Aito et al., 80% of the neurologically improved patients had been treated surgically [10] . ...
... The potential chance of neurological recovery, the prevention of general complications and the early possibility of mobilisation with stable treatment of the cervical spine speak in favour of primary surgical treatment. Our patients show a neurological improvement in 34.4% of cases, which is comparable to the data of Grassner et al., with results of 38.7% [32] . Significant differences in the development possibilities exist between complete and incomplete paraplegia upon admission. ...
Aim:
To describe demographic findings, typical injuries and functional neurological outcomes in patients with cervical trauma and tetraplegia sustained after diving into shallow water.
Patients and methods:
A retrospective study was performed including all patients treated in BG Klinikum Hamburg suffering from tetraplegia after jumping into shallow water between 1st June 1980 and 31st July 2018.
Results:
One hundred and sixty patients with cervical spinal injuries and tetraplegia following a dive into shallow water were evaluated. Of these, 156 patients (97.5%) were male. The mean age was 24.3 years ± 8.1 and the accidents occurred most often in inland waters (56.2%) and mostly between May and August (90.6%). In all cases there was one vertebra fractured, whereas in 48.1% of cases, two vertebrae were severed. In the majority of cases (n = 146), a surgical procedure was performed. Overall, the mean hospital stay was 202 days (±72, range: 31-403) and one patient died. On admission, 106 patients (66.2%) showed a complete lesion according to AIS A, with incomplete lesions in the remaining 54 patients (AIS B: n = 25 [15.6%], AIS C: n = 26 [16.3%], AIS D: n = 3 [1.9%]). In two thirds of the patients, the level of paralysis on admission was at the level of segments C4 (31.9%) or C5 (33.7%). Seventeen patients (10.6%) needed prehospital resuscitation. In 55 patients (34.4%), the neurological findings improved during the course of inpatient treatment and rehabilitation. Sixty-eight patients (42.5%) developed pneumonia, of which 52 patients (76.5%) were ventilated. In addition, 56.5% of patients with paralysis levels C0-C3 required ventilation, whereas only 6.3% of patients with paralysis levels C6-C7 were affected. Three patients (1.9%) were discharged from hospital with continuous ventilation. Overall, 27.4% of all AIS A patients, 56% of all AIS B patients and 46.2% of all AIS C patients improved neurologically, with 17% of all patients being able to walk.
Conclusions:
The consequences of a cervical spine injury after diving into shallow water are severe and lifelong. Functionally, patients may benefit from care in a specialised centre, both in the acute phase and during rehabilitation. The more incomplete the primary paralysis, the greater the possibility of neurological recovery.
... Furthermore, the timing for these trauma surgeries is unclear in many studies as timing for trauma surgeries was outside the scope of the papers. Understanding the feasibility of robot-assisted pedicle screw placement in acute trauma is of the utmost importance as recent research has suggested early decompression (<8 hours) and instrumentation after a spinal cord injury is optimal [12,13]. ...
... Understanding the feasibility of robot-assisted spine surgery is important as research on spinal cord injuries suggests hyperacute (<8 hours post-injury) decompression should be performed. Jug et al. and Grassner et al. demonstrated improved neurological outcomes for hyperacute (<8 hours post-injury) versus acute surgery (9-24 hours post-injury) [12,13]. Therefore, choosing a method with superb accuracy, efficiency, and reliability is fundamental to successful surgery. ...
Background:
Pedicle screw fixation has become the workhorse for the stabilization of the thoracolumbar spine. Since accurate pedicle screw placement is necessary for a successful surgery, three-dimensional navigation has become a mainstay for placing pedicle screws. However, the published studies have an overrepresentation of lumbar screws despite the prevalence of thoracic fractures. Furthermore, no robotic-assisted pedicle screw study has focused solely on traumatic fractures. The goal of this study was to address whether (1) robot-assisted pedicle screw placement had comparable accuracy in the thoracic and thoracolumbar region and (2) robot-assisted spine surgery was feasible in an acute, traumatic setting.
Methods:
We performed 14 consecutive, thoracolumbar spinal stabilization procedures in which 126 pedicle screws were placed using the Globus ExcelsiusGPS® spine robot in an acute, traumatic setting. Operative times were measured, and the accuracy of pedicle screws was assessed with the Gertzbein and Robbins classification system by two board-certified neuroradiologists.
Results:
A total of 60-thoracic (T3-T11), the 24-thoracolumbar junction (T12-L1), 40-lumbar (L2-L5), and two-sacral pedicle screws were placed. Pedicle screw placement was accurate with a < 1% (1/126) pedicle breach rate. Thoracolumbar robotic spine surgery in an acute, traumatic setting was demonstrated to have a good safety profile with only one minor neurological deficit which was related to positioning. Furthermore, surgical times were inversely related to the case number.
Conclusions:
These results together suggest that robot-assisted spine surgery is accurate in the thoracic spine. Furthermore, placement of thoracolumbar screws in an acute trauma is non-inferior to other methods when based on accuracy.
