Value of gas myelography in early management of acute cervical spinal cord injuries

Evaluation of acute nonpenetrating cervical spinal cord injuries with CT metrizamide myelography

Computerized tomography metrizamide myelography was performed in 46 patients with acute, nonpenetrating cervical spinal cord injuries. By visualizing the spinal canal, spinal cord, and any compressive lesion, the study proved valuable in the decision as to whether surgical decompression was indicated and what approach should be used. Eleven patients were found to have significant spinal cord compression, 10 of whom were treated surgically. The technique, results, and complications resulting from the study are discussed.

The demonstration and significance of neural compression after spinal injury

Standard metrizamide myeLography and CT myelography can accurately and safely define neural compression after a spinal injury. A lateral C1-C2 spinal puncture and a radiolucent fracture board reduce movement of the spine, and by injecting metrizamide in an isotonic concentration and by limiting the amount of contrast above a block, the risk of seizure is minimized. This capability for directly determining neural compression has important implications for the treatment of spinal fractures, and the significance of persisting posttraumatic neural compression is discussed. We believe neural compression should be the primary indication for surgical decompression after spinal injury and that evaluation for it should now be a standard part of the examination of patients with spinal fractures with potential for neurological recovery.

Treatment of severe cervical spine injuries by anterior interbody fusion with early mobilization

A follow up study of 24 patients treated for severe injury of the cervical spine is presented. The dislocation was initially reduced by skull traction, which was later replaced by anterior fusion using a tibial graft. Solid fusion occurred in all patients. The neurological improvement was unaffected by the operation. Our conclusion is that anterior fusion as opposed to conservative treatment leads to earlier mobilization, shorter hospitalization, and less costly rehabilitation.

The prognosis of patients sustaining severe cervical spine injury (C2-C7 inclusive)

In a study of 145 patients with severe cervical spine injury, it was found that 79 had serious neurological disturbance. A policy of the earliest possible referral to a spinal paralysis service is recommended. Associated injuries and in particular a head injury can make early precise neurological diagnosis difficult, and may affect management of the spinal injury. The use of Gardner Wells Skull Tongs and the Edinburgh Simpson Bed is recommended. Early spinal operation does not influence outcome of neurological function. Anatomical re-alignment of the spine is not essential for neurological recovery. Myelography is very rarely of benefit in assisting diagnosis and treatment. Glucocorticosteroids and Mannitol do not appear to influence neurological recovery. The prognosis in relation to clinical neurological syndromes is discussed.

Progressive neurological dysfunction secondary to postoperative cervical pseudomeningocele in a C-4 quadriplegic. Case report

A case is detailed of a patient who developed progressive neurological deficit above a fixed quadriplegic level at C-4 18 years after posterior cervical decompression for trauma. Diagnostic evaluation revealed a pseudomeningocele at the site of his previous surgery. Subsequent operative closure resulted in reversal of his neurological symptoms.

Reduced morbidity in gas myelography

Gas myelography is a useful technique in the evaluation of the spinal canal and its contents. Although it has been greatly simplified and the high-resolution imaging greatly improved, morbidity remains a problem. Removal of the gas at the end of the examination through the lumbar route significantly decreases morbidity. This can be achieved through the same needle if the examination is performed via a lumbar puncture. Insertion of a second needle in the lumbar region may be necessary if the cervical or cisternal puncture is employed for gas introduction.

Is positive-contrast myelography of value in acute cervical spinal cord injury?

Positive-contrast myelography in 30 patients with acute cervical spinal cord injury has not provided any information of clinical value. Reference to the literature does not provide a definite set of indications for myelography in acute spinal cord injury. An attempt has therefore been made to evaluate the indications for this procedure. The potential hazards of myelography in patients with acute spinal cord injury are discussed. Specific contra-indications are described. Difficulties in the radiological interpretation of the usual myelographic appearances in spinal cord injury are mentioned. The advantages of negative-contrast myelography are briefly described. It is concluded that there is a very limited indication for positive-contrast myelography in acute spinal cord injury.

Myelography for severe thoracolumbar injuries

Myelography was carried out on 30 patients with severe thoracolumbar injuries. In ten cases the myelography gave specific information which could not have been obtained by any other method. Myelography made within 1 month of trauma gave specific information in only one of 16 cases. Late myelography, in nine of 14 cases, provided valuable specific information about the type of cord atrophy, dorsal scar formation and transsection of the cord.

Oxygen myelography for cervical spinal cord injuries

Oxygen myelographies were performed on 15 patients with cervical spinal cord injuries, in seven of whom narrowing of the spinal cord was caused by a fracture-dislocation. In eight the fracture was of bursting type, and the neurological involement in these was more severe than in the former type. The main findings in seven early myelograms were swelling of the cord (3/7) and non-visualization of the spinal canal at the injury level (6/7). The main findings in eight late myelograms were narrowing of the cord (5/8) and anterior stretching of the cord over the obstructing bony ridge.