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Liu R, Fan Q, He J, Wu X, Tan W, Yan Z, Wang W, Li Z, Deng YW. Clinical characteristics analysis of pediatric spinal cord injury without radiological abnormality in China: a retrospective study. BMC Pediatr 2024; 24:236. [PMID: 38570804 PMCID: PMC10988788 DOI: 10.1186/s12887-024-04716-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/21/2024] [Indexed: 04/05/2024] Open
Abstract
PURPOSE This study aims to analyze the clinical characteristics of Chinese children with spinal cord injury (SCI) without radiographic abnormality (SCIWORA) and explore their contributing factors and mechanisms of occurrence. METHODS A retrospective analysis was conducted on the clinical data of pediatric patients diagnosed with SCIWORA from January 2005 to May 2020. Epidemiological, etiological, mechanistic, therapeutic, and outcome aspects were analyzed. RESULTS A total of 47 patients with SCIWORA were included in this study, comprising 16 males and 31 females. The age range was 4 to 12 years, with an average age of 7.49 ± 2.04 years, and 70% of the patients were below eight. Sports-related injuries constituted 66%, with 70% attributed to dance backbend practice. Thoracic segment injuries accounted for 77%. In the American Spinal Injury Association (ASIA) classification, the combined proportion of A and B grades accounted for 88%. Conservative treatment was chosen by 98% of the patients, with muscle atrophy, spinal scoliosis, hip joint abnormalities, and urinary system infections being the most common complications. CONCLUSION SCIWORA in Chinese children is more prevalent in those under eight years old, with a higher incidence in females than males. Thoracic spinal cord injuries are predominant, dance backbend as a primary contributing factor, and the social environment of "neijuan" is a critical potential inducing factor. Furthermore, the initial severity of the injury plays a decisive role in determining the prognosis of SCIWORA.
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Affiliation(s)
- Renfeng Liu
- Department of Spinal Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Qizhi Fan
- Department of Spinal Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Jingpeng He
- Department of Spinal Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Xin Wu
- Department of Spinal Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Wei Tan
- Department of Spinal Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Zuyun Yan
- Department of Spinal Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Weiguo Wang
- Department of Spinal Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Zhiyue Li
- Department of Spinal Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - You-Wen Deng
- Department of Spinal Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China.
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Romero-Muñoz LM, Peral-Alarma M, Barriga-Martín A. [Translated article] SCIWORA in children. A rare clinical entity: Ambispective study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T151-T158. [PMID: 37995819 DOI: 10.1016/j.recot.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/22/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION SCIWORA has a low incidence but a high functional repercussion. The aim of the present study was to characterize the epidemiology of this clinical-radiological condition and evaluate functional outcome with a mean of 10-years follow-up. MATERIAL AND METHODS Observational, longitudinal ambispective cohort study. Thirteen SCIWORA patients were admitted in the study period. Demographics, mechanism of injury, spinal cord MRI findings, neurological level of injury, time to SCI, neurological status (AIS) at admission/discharge/5 years, spinal cord independence measure (SCIM III) scale at admission and discharge, hospital length of stay and mean follow-up were recorded. On October 2022 patients were re-evaluated using NDI, Oswestry, and SV-QLI/SCI. RESULTS Median age was 4 years. The study population for this investigation was mostly men (77%). 54% of level of injury correspond to cervical spine. AIS at admission was A (31%) and C (31%). Neurological level of injury was C2 (22%) and T10 (15%). Motor vehicle-related injury was the most prevalent mechanism of injury (77%), SCIM III scale at admission and discharge: 28.5/42, hospital length of stay was 115 days. The NDI was 11.6, Oswestry: 15.3 and SV-QLI/SCI: 17. CONCLUSIONS Seventy-seven percent of SCIWORA patients was detected under 8 years-old. At 1 year follow-up after discharge 31% patients were AIS grade D and with 5 years follow-up the percentage remain constant. No statistically significant differences in the mechanism of injury and MRI findings (P=0.872), age and MRI spinal cord findings (P=0.149) were found in SCIWORA patients.
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Affiliation(s)
- L M Romero-Muñoz
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Nacional de Parapléjicos, Toledo, Spain.
| | - M Peral-Alarma
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Nacional de Parapléjicos, Toledo, Spain
| | - A Barriga-Martín
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Nacional de Parapléjicos, Toledo, Spain
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Romero-Muñoz LM, Peral-Alarma M, Barriga-Martín A. SCIWORA in children. A rare clinical entity: Ambispective study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:151-158. [PMID: 37689351 DOI: 10.1016/j.recot.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/23/2023] [Accepted: 08/22/2023] [Indexed: 09/11/2023] Open
Abstract
INTRODUCTION SCIWORA has a low incidence but a high functional repercussion. The aim of the present study was to characterize the epidemiology of this clinical-radiological condition and evaluate functional outcome with a mean of 10-years follow-up. MATERIAL AND METHODS Observational, longitudinal ambispective cohort study. Thirteen SCIWORA patients were admitted in the study period. Demographics, mechanism of injury, spinal cord MRI findings, neurological level of injury, time to SCI, neurological status (AIS) at admission/discharge/5 years, spinal cord independence measure (SCIM III) scale at admission and discharge, hospital length of stay and mean follow-up were recorded. On October 2022 patients were re-evaluated using NDI, Oswestry, and SV-QLI/SCI. RESULTS Median age was 4 years. The study population for this investigation was mostly men (77%). 54% of level of injury correspond to cervical spine. AIS at admission was A (31%) and C (31%). Neurological level of injury was C2 (22%) and T10 (15%). Motor vehicle-related injury was the most prevalent mechanism of injury (77%), SCIM III scale at admission and discharge: 28.5/42, hospital length of stay was 115 days. The NDI was 11.6, Oswestry: 15.3 and SV-QLI/SCI: 17. CONCLUSIONS Seventy-seven percent of SCIWORA patients was detected under 8 years-old. At 1 year follow-up after discharge 31% patients were AIS grade D and with 5 years follow-up the percentage remain constant. No statistically significant differences in the mechanism of injury and MRI findings (P = 0.872), age and MRI spinal cord findings (P = 0.149) were found in SCIWORA patients.
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Affiliation(s)
- L M Romero-Muñoz
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Nacional de Parapléjicos, Toledo, España.
| | - M Peral-Alarma
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Nacional de Parapléjicos, Toledo, España
| | - A Barriga-Martín
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Nacional de Parapléjicos, Toledo, España
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Kavanagh MD, Jain V, Rascoe AS, Ritter KA, Kelly ML, Vallier HA, Como JJ. Canal narrowing in adult patients with cervical spinal cord injury without computed tomography evidence of trauma. Clin Imaging 2023; 99:67-72. [PMID: 37119564 DOI: 10.1016/j.clinimag.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/05/2023] [Indexed: 05/01/2023]
Abstract
PURPOSE Cervical spinal cord injury can be a particularly devastating sequela of trauma. The purpose of this study was to describe the imaging findings of adult patients with cervical spinal cord injury without computed tomography evidence of trauma (SCIWOCTET). METHODS All adult patients (≥18 years) treated for acute cervical SCIWOCTET at a single Level I adult trauma center over an eight-year period were retrospectively identified. CT imaging was evaluated for degenerative changes narrowing the midsagittal canal diameter (SCD) of the cervical spine and relative congenital cervical stenosis (CCS; congenital narrowing of the SCD <13 mm). Magnetic resonance imaging (MRI) scans were evaluated for signal intensity change (SIC) suspicious for cord edema/contusion as well as ligamentous injury, hemorrhage, and epidural hematoma. RESULTS Ninety-six patients with cervical SCIWOCTET met inclusion criteria. The most common mechanism of injury was fall from standing (47.9%). On CT, 86 patients (89.6%) had CCS. Degenerative changes were present in 95 patients (99.0%). In 98/99 patients (99.0%), the point of narrowest cervical SCD was ≤8 mm. On MRI, 79 patients (82.3%) demonstrated signal intensity change (SIC) indicative of cord edema/contusion, while 16 (16.7%) had ligamentous injury. Intramedullary cord hemorrhage was seen in two patients (2.1%) and epidural hematoma in three (3.1%). CONCLUSION Degenerative changes or CCS may narrow the minimum cervical SCD beyond the threshold at which low-energy trauma results in C-SCI. Adult patients with cervical spinal stenosis, whether congenital and/or degenerative, and neurologic findings referable to the cervical spine should be assessed for C-SCI.
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Affiliation(s)
- Michael D Kavanagh
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Vikas Jain
- Department of Radiology, MetroHealth Medical Center, Cleveland, OH, USA
| | - Alexander S Rascoe
- Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kaitlin A Ritter
- Department of Surgery, MetroHealth Medical Center, Cleveland, OH, USA
| | - Michael L Kelly
- Department of Neurological Surgery, MetroHealth Medical Center, Cleveland, OH, USA
| | - Heather A Vallier
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, OH, USA
| | - John J Como
- Department of Surgery, MetroHealth Medical Center, Cleveland, OH, USA
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Kalanjiyam GP, Kanna RM, Rajasekaran S. Pediatric spinal injuries- current concepts. J Clin Orthop Trauma 2023; 38:102122. [PMID: 36846073 PMCID: PMC9945789 DOI: 10.1016/j.jcot.2023.102122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/03/2023] [Indexed: 02/05/2023] Open
Abstract
Spinal injuries in children contribute to the highest mortality and morbidity among all pediatric injuries. Fortunately, these injuries are a rare clinical entity but pose a difficulty in diagnosis due to challenges in neurological evaluation of a child and varied radiological presentation. Anatomical and biomechanical aspects of developing musculoskeletal system, relative plasticity of the pediatric spine make children vulnerable to spine injuries. Though motor vehicle collisions are common, children also suffer non-accidental trauma, falls and sports injuries. More chances of cervical spine involvement, higher susceptibility of spinal cord to tensile forces and associated multisystem injuries result in devastating consequences in children compared to adults. Injuries like SCIWORA, vertebral apophyseal injuries, birth-related spinal cord injuries are more specific injuries in pediatric age group. A vigilant clinical, neurological and radiological evaluation is mandatory in all children with suspected spinal injuries. Normal radiological features like ossification centers, pseudosubluxation and physiological vertebral wedging should be carefully noted as they could be misinterpreted as injuries. While CT scans help in better understanding of the fracture pattern, Magnetic Resonance Imaging in children is beneficial especially in detecting SCIWORA and other soft tissue injuries. Management principles of these pediatric spinal injuries are similar to adults. Literature evidences support conservative management in injuries like SCIWORA, unless there is an ongoing spinal cord compression. As in adults, the role of high dose methylprednisolone is still controversial in pediatric spinal cord injuries. Stable spinal injuries can be managed conservatively using orthosis or halo. Instrumentation by both anterior and posterior techniques has been described, but it is challenging due to smaller anatomy and poor implant purchase. In addition to pedicle screw instrumentation, wiring techniques are very beneficial especially in younger children.
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Affiliation(s)
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India
| | - S. Rajasekaran
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India
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Zeng L, Wang YL, Shen XT, Zhang ZC, Huang GX, Alshorman J, Serebour TB, Tator CH, Sun TS, Zhang YZ, Guo XD. Guidelines for management of pediatric acute hyperextension spinal cord injury. Chin J Traumatol 2023; 26:2-7. [PMID: 36137934 PMCID: PMC9912180 DOI: 10.1016/j.cjtee.2022.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/21/2022] [Accepted: 06/11/2022] [Indexed: 02/04/2023] Open
Abstract
Pediatric acute hyperextension spinal cord injury (SCI) named as PAHSCI by us, is a special type of thoracolumbar SCI without radiographic abnormality and highly related to back-bend in dance training, which has been increasingly reported. At present, it has become the leading cause of SCI in children, and brings a heavy social and economic burden. Both domestic and foreign academic institutions and dance education organizations lack a correct understanding of PAHSCI and relevant standards, specifications or guidelines. In order to provide standardized guidance, the expert team formulated this guideline based on the principles of science and practicability, starting from the diagnosis, differential diagnosis, etiology, admission evaluation, treatment, complications and prevention. This guideline puts forward 23 recommendations for 14 related issues.
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Affiliation(s)
- Lian Zeng
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yu-Long Wang
- Department of Orthopedics, Wuhan No. 1 Hospital, Wuhan Integrated TCM & Western Medicine Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xian-Tao Shen
- Department of Pediatric Orthopaedic Surgery, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Zhi-Cheng Zhang
- Department of Orthopedics, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China
| | - Gui-Xiong Huang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jamal Alshorman
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Tracy Boakye Serebour
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Charles H. Tator
- Toronto Western Research Institute, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Tian-Sheng Sun
- Department of Orthopedics, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China,Corresponding author. suntiansheng-@163.cm
| | - Ying-Ze Zhang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China.
| | - Xiao-Dong Guo
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Yadav A, Singh A, Verma R, Singh VK, Ojha BK, Chandra A, Srivastava C. Pediatric Cervical Spine Injuries. Asian J Neurosurg 2022; 17:557-562. [PMID: 36570758 PMCID: PMC9771637 DOI: 10.1055/s-0042-1757728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective Pediatric cervical spine injuries are rare and account for 1 to 2% of all pediatric spine injuries. There is a paucity of data on pediatric cervical spine injuries in developing countries like India. The purpose of this study is to review and analyze our 5 years of experience with pediatric cervical spine injuries. Methods All the available medical records over the 5 years were reviewed retrospectively. The data was analyzed to know the epidemiology, mechanism of injury, injury patterns, management, and outcome. The patients were divided into two groups: 0 to 9 years and 10 to 18 years. Results Seventy-five eligible records were included in our study. The incidence of cervical spine injuries was significantly lower in younger children than the older ones ( p < 0.042). The most common mechanism of injury was fall from height: 33 (44%) patients followed by road traffic accidents: 27 (36%) patients. The involvement of the upper cervical spine was significantly higher in younger children ( p < 0.001). Fractures with subluxation were the most common pattern of injury, observed in 35 (47%) patients. However, fractures with subluxation were uncommon in younger children compared with older children ( p < 0.04). Spinal cord injury without radiographic abnormality (SCIWORA) was observed in 42% of younger children compared with 8% of older children ( p < 0.02). Thirty (40%) patients were managed surgically; anterior cervical corpectomy with fusion was the most commonly performed procedure in 19 (63%) patients. The overall mortality was 20%. Conclusion The results of our study revealed predominant involvement of the upper cervical spine in children younger than 10 years of age. SCIWORA was documented in both the age groups with a significantly higher incidence in younger children. The instrumentation and fusion techniques in children are safe; however, developing pediatric spine needs special considerations.
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Affiliation(s)
- Awdhesh Yadav
- Department of Neurosurgery, King George's Medical University, Lucknow, Uttar Pradesh, India,Address for correspondence Awdhesh Yadav, MS, MCh Department of Neurosurgery5th Floor, Shatabdi Hospital Phase-2, King George's Medical University, Lucknow, Uttar Pradesh, 226003India
| | - Aneeta Singh
- PDCC (Neuro-anesthesia), King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rajat Verma
- Department of Neurosurgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vijay K. Singh
- Department of Social and Preventive Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Bal K. Ojha
- Department of Neurosurgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Anil Chandra
- Department of Neurosurgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Chhitij Srivastava
- Department of Neurosurgery, King George's Medical University, Lucknow, Uttar Pradesh, India
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Qi C, Cao J, Xia H, Miao D, Liu Y, Guo J, Li Z, Hou Z. Does cervical curvature affect neurological outcome after incomplete spinal cord injury without radiographic abnormality ( SCIWORA): 1-year follow-up. J Orthop Surg Res 2022; 17:361. [PMID: 35883148 PMCID: PMC9327310 DOI: 10.1186/s13018-022-03254-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background At present, surgery is the primary clinical treatment for SCIWORA patients, but conservative treatment still plays an important role in patients with incomplete spinal cord injury. As an important index of cervical spine degeneration, cervical curvature has an impact on the prognosis of spinal cord injury patients. This paper studied the prognosis of conservatively treated patients with SCIWORA and the correlation between cervical curvature and neurological prognosis. Methods A retrospective study was conducted in all the patients with SCI admitted to the Third Affiliated Hospital of Hebei Medical University between January 2017 and June 2020. Data were recorded in 106 eligible patients, including sex, age, injury factors, Cobb angle, CCI, CSA, and ASIA motor and sensory scores. The Wilcoxon sign rank sum test was used to analyze the data postinjury and at the 1-year follow-up. Pearson correlation analysis was performed for the Cobb angle, CCI and CSA. Simple linear regression analysis and multiple linear regression analysis were performed for each group of variables. Results The Wilcoxon signed rank sum test confirmed that the Cobb angle, the CCI and the CSA of the patients were not significantly different at the 1-year follow-up when compared with the postinjury values, and the ASIA motor and sensory scores were significantly improved. The Pearson correlation analysis showed correlations among the Cobb angle, the CCI and the CSA. Simple linear regression analysis and multiple linear regression analysis showed that the nerve recovery rate was negatively correlated with age and was positively correlated with the Cobb angle. Conclusion Conservative treatment of incomplete SCIWORA can achieve a good prognosis.
There is a clear correlation between the Cobb angle, CCI and CSA, and the Cobb angle, as an important influencing factor, needs to be considered. For SCIWORA patients undergoing nonsurgical treatment, improving cervical curvature is beneficial to the prognosis of patients. Age negatively affects the neurological prognosis.
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Affiliation(s)
- Can Qi
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China.,Key Laboratory of Biomechanics of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Junming Cao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Hehuan Xia
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Dechao Miao
- Department of Spinal Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Yaming Liu
- Department of Spinal Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Junfei Guo
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China.,Key Laboratory of Biomechanics of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Zequn Li
- The Department of Radiology, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China. .,Key Laboratory of Biomechanics of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China. .,NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, Hebei Province, China.
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Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVE The SCIWORA Syndrome (Spinal Cord Injury Without Radiographic Abnormalities) is a rare but potentially severe injury with a peak in childhood and adolescence. With a better understanding of injury patterns and advances in MRI, there is ongoing discussion regarding the "Real SCIWORA" syndrome, a clinical picture of neurologic deficits on clinical examination but absence of radiographic pathologies even on MRI. The purpose of this study was to evaluate mid-term clinical outcome and the psychological impact of the "Real SCIWORA." METHODS In this retrospective analysis, we evaluated 32 patients treated for "Real SCIWORA" between 2007-2019. Inclusion criteria were: neurologic deficit after trauma, no other cerebral or skeletal injury and a lack of pathological findings in spinal MRI. All patients were followed until complete recovery from initial symptoms. 25/32 patients were re-evaluated after 6.9 years (1-14 years) using the Oswestry Disability Index, the Frankel Score, the EQ-5D score, and the Breslau Short Screening Scale for PTSD. RESULTS Initial neurologic presentation ranged from Frankel Grade A-D. All patients recovered neurologically during 1-13 days to a Frankel Grade E. The analysis of HR-QoL revealed no difference between the cohort of SCIWORA patients and the German population norm, Oswestry Disability Index showed only minimal disabilities. 4/25 patients showed signs of PTSD. CONCLUSIONS The "Real SCIWORA" syndrome is a diagnosis per exclusionem requiring a full spinal MRI to ensure exclusion of structural and potentially serious reasons of the neurologic impairment. Further clinical re-evaluation, psychological support seems to be essential. LEVEL OF EVIDENCE IV-retrospective study.
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Affiliation(s)
- Viola Freigang
- Department of Trauma, Regensburg University Medical Center, Regensburg, Germany,Viola Freigang, Department of Trauma Surgery, Regensburg University Medical Center, Franz-Josef-Strauss Allee 11, 93053 Regensburg, Germany.
| | - Katja Butz
- Department of Trauma, Regensburg University Medical Center, Regensburg, Germany
| | | | - Julia Karnosky
- Department of Surgery, Regensburg University Medical Center, Regensburg, Germany
| | - Siegmund Lang
- Department of Trauma, Regensburg University Medical Center, Regensburg, Germany
| | - Volker Alt
- Department of Trauma, Regensburg University Medical Center, Regensburg, Germany
| | - Florian Baumann
- Department of Trauma, Regensburg University Medical Center, Regensburg, Germany
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Liang J, Wang L, Hao X, Wang G, Wu X. Risk factors and prognosis of spinal cord injury without radiological abnormality in children in China. BMC Musculoskelet Disord 2022; 23:428. [PMID: 35524245 PMCID: PMC9074214 DOI: 10.1186/s12891-022-05393-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Compared to adults, spinal cord injury without radiographic abnormality (SCIWORA) is more common in children due to the congenital spinal soft tissue elasticity and immature vertebral bodies. In this study, we aimed to investigate the risk factors and prognosis associated with SCIWORA in China. Method We retrospectively examined patient records at the First Hospital of Jilin University from January 2007 to December 2020. Patients diagnosed with SCIWORA were included in the study group (n=16). The age, gender, history of trauma, symptoms, injury level of the spinal cord, the American Spinal Injury Association (ASIA) impairment score according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), as well as laboratory and imaging findings were analyzed. Result The study group included 16 patients with SCIWORA with a mean age of 6.69±2.51 y. The ISNCSCI impairment scale was significantly different between the pre-school age patients (≤7 years old) and school age patients (>7 years old) before (P=0.044) and after therapy (P=0.002). Similarly, magnetic resonance imaging demonstrated a significant difference in the spinal injury level between pre-school age and school age patients (P=0.041). Further, the study group was subdivided into three subgroups according to the cause of trauma: Dance, Taekwondo, or Falls. Magnetic resonance imaging revealed significant differences among the three subgroups (P=0.041). Conclusion Compared to school-age patients, pre-school-age patients were more vulnerable to SCIWORA with more severe ISNCSCI scores. Dance and Taekwondo are among the risk factors associated with SCIWORA in Chinese children.
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Affiliation(s)
- Jianmin Liang
- Department of Pediatric Neurology, First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130000, Jilin Province, China.,Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, China
| | - Linyun Wang
- Department of Pediatric Neurology, First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130000, Jilin Province, China
| | - Xiaosheng Hao
- Department of Pediatric Neurology, First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130000, Jilin Province, China
| | - Guangliang Wang
- Department of Cardiology, Jiren Hospital of Far Eastern Horizon, Anda, P. R. China
| | - Xuemei Wu
- Department of Pediatric Neurology, First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130000, Jilin Province, China. .,Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, China.
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García-Cabra DA, Jerez-Fidencio D. [Diagnosis of SCIWORA associated with Brown Séquard syndrome in an adolescent]. Acta Ortop Mex 2021; 35:557-559. [PMID: 35793257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
SCIWORA (Spinal Cord Injury without Radiologic Abnormality) is a rare condition that mainly affects pediatric patients; We present the case of a teenage male patient diagnosed with SCIWORA/Brown Séquard Syndrome. In admission, he has multiple bruises on his neck and right hemibody and immediately he refers paraesthesia in all four limbs and spastic hemiparesis with right predominance, as well as inability to stand up and urinary continence. Treatment based on NASCIS III study is initiated and after the imaging tests, a diagnosis has already been made. We present the most current definitions of SCIWORA and the recommendations to make its diagnosis, as well as its relationship and coexistence with spinal syndromes.
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Affiliation(s)
- D A García-Cabra
- Facultad de Medicina, Campus Minatitlán, Universidad Veracruzana, Veracruz, México
| | - D Jerez-Fidencio
- Departamento de Traumatología y Ortopedia, Hospital General de Zona No. 32, Minatitlán. Veracruz, México
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Booker J, Hall S, Dando A, Dare C, Davies E, McGillion S, Mathad N, Waters R, Tsitouras V, Mundil N, Wahab S, Chakraborty A. Paediatric spinal trauma presenting to a UK major trauma centre. Childs Nerv Syst 2021; 37:1949-1956. [PMID: 33515056 DOI: 10.1007/s00381-021-05044-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/14/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Paediatric spine trauma is uncommon and is managed differently from adults due to the anatomical differences of the paediatric spine. The paediatric spine is less ossified, with lax ligaments and a higher fulcrum in the c-spine which results in a different pattern of injuries. The aim of this study is to provide a contemporary audit of paediatric spinal trauma. METHODS A retrospective review was conducted using the Trauma and Audit Research Network database at a major trauma centre (2011-2018). All patients < 18 years old with a spine injury underwent case note and radiology review. RESULTS A total of 72 patients (37, 51.4% male with an average age of 13.3 (± 5.9) years old) were identified. The most common mechanism of injury was road traffic collisions (n = 39, 54.2%). The most common sporting cause was motocross accidents (n = 6, 8.3%), and a further 6 (8.3%) patients had a suspected inflicted injury. Eight patients (11.1%) sustained a spinal cord injury. Twenty-seven (37.5%) patients underwent surgical intervention to treat their spinal injury. CONCLUSION This series demonstrates the profile of injury mechanisms causing paediatric spinal injuries. Paediatric spine injuries continue to have the potential for lifelong disability and require careful, specialist management. This series also highlights certain causes such as motocross accidents and suspected inflicted injury which are more frequent than expected and raise potential public health concerns.
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Affiliation(s)
- James Booker
- Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Samuel Hall
- Department of Neurosurgery, Wessex Neurological Centre, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - Alexander Dando
- Department of Neurosurgery, Wessex Neurological Centre, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Christopher Dare
- Department of Orthopaedics, Southampton General Hospital, Southampton, UK
| | - Evan Davies
- Department of Orthopaedics, Southampton General Hospital, Southampton, UK
| | - Stephen McGillion
- Department of Orthopaedics, Southampton General Hospital, Southampton, UK
| | - Nijaguna Mathad
- Department of Neurosurgery, Wessex Neurological Centre, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Ryan Waters
- Department of Neurosurgery, Wessex Neurological Centre, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Vassilios Tsitouras
- Department of Neurosurgery, Wessex Neurological Centre, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Nilesh Mundil
- Department of Neurosurgery, Wessex Neurological Centre, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Salima Wahab
- Department of Neurosurgery, Wessex Neurological Centre, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Aabir Chakraborty
- Department of Neurosurgery, Wessex Neurological Centre, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
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Abstract
STUDY DESIGN Retrospective study. OBJECTIVE The purpose of the study was to analyze the epidemiological parameters and associated factors after spinal cord injury (SCI) in children, in the last 14 years admitted at a tertiary care center (Indian Spinal Injury Centre [ISIC], New Delhi, India). METHOD The demographic and injury-related data was analyzed descriptively. The incidence, type, and level of injury were compared across the age groups using a χ2 test. Wherever appropriate, Fisher exact test was used. RESULTS There were 1660 pediatric trauma cases admitted at ISIC from 2002 to 2015, where 204 cases presented with spine injuries. The average age of children sustaining spine injury was 15.69 years (3-18 years of range). There were 15 patients in the age group 0 to 9 years, 27 patients in the age group 10 to 14 years, and 162 patients in the age group 15 to 18 years. This difference in spine injury incidence among the age groups was statistically significant. Fall from height was a common mode of injury. In our sample, boys were 3 times more likely to be injured than girls. Burst fractures were common among the type of injuries. CONCLUSION Our study confirms the predominance of cervical spine injury and the high incidence of multilevel contiguous with a lesser percentage of noncontiguous multilevel spinal involvement. SCIWORA (spinal cord injury without radiological abnormality) incidences were in a similar context to the literature available. There was a very low incidence of death. Neurological improvement was seen in 8 operated cases and 4 conservatively treated cases.
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Affiliation(s)
- M. L. Bansal
- Indian Spinal Injuries Centre, New Delhi, India
- M. L. Bansal, Department of Spine Services, Indian Spinal Injuries Centre, Sector C, Vasant Kunj, New Delhi 110070, India.
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Compagnon R, Ferrero E, Leroux J, Lefevre Y, Journeau P, Vialle R, Glorion C, Violas P, Chalopin A, Odent T, Haddad E, Nallet J, Garin C, Choufani E, Langlais T, Sales de Gauzy J; French Society of Spinal Surgery (SFCR), French Society of Pediatric Orthopedics (SOFOP). Epidemiology of spinal fractures in children: Cross-sectional study. Orthop Traumatol Surg Res 2020; 106:1245-9. [PMID: 33060015 DOI: 10.1016/j.otsr.2020.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/09/2020] [Accepted: 06/19/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Epidemiological studies of fractures of the spine in children are all old, mostly single-centre, with series spanning periods of 5 to 20 years. HYPOTHESIS As lifestyle is constantly changing, notably with an increase in sports activities and improvements in the prevention of road and household accidents, epidemiology has likely changed. OBJECTIVE To update the description of spinal trauma in children and adolescents compared to the existing literature. MATERIAL AND METHOD A multicentre cross-sectional study of spinal fracture, dislocation and spinal cord injury without radiological abnormality (SCIWORA) in children was carried out in 15 French university hospital centres, for a period of one year (2016). RESULTS One hundred and sixty-five children were identified: 85 girls, 80 boys; mean age 11 years (range, 10 months-17 years); median, 12 years 6 months. One hundred and fifty-two children (92%) had fracture, 8 (5%) dislocation (including 7 C1-C2 rotary dislocations), and 5 (3%) SCIWORA. Fractures were multiple in 80 cases (49%), contiguous in 73 cases (91%) and non-contiguous in 7 (9%). Locations were cervical in 25 cases (15%), thoracic in 85 (52%), lumbar in 75 and sacral in 4 (2%). Fracture types comprised 234 vertebral compactions (78%), 25 burst fractures (8%), 5 chance fractures (2%), 2 odontoid fractures, and 33 other lesions. Causes comprised fall in 77 cases (47%), sports accidents in 56 (34%), road accidents in 29 (18%), and others in 3. In 52 cases (32%), there was ≥1 associated lesion: appendicular in 35 cases (67%), thoracic or abdominal in 31 (60%), and head in 16 (31%). Twenty-one cases had multiple lesions (40%). Eighteen cases showed neurological involvement (11%) including 5 SCIWORAs. Neurological complications were more frequent before 9 years of age. CONCLUSION The epidemiology of spine fractures in children has slightly changed. There are now fewer cervical lesions. Causes are less often road accidents and more often sports accidents. Multi-level lesions remain frequent and the rate of neurological complications is around 10%. Compaction fracture is the most common type.
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Qi C, Xia H, Miao D, Wang X, Li Z. The influence of timing of surgery in the outcome of spinal cord injury without radiographic abnormality ( SCIWORA). J Orthop Surg Res 2020; 15:223. [PMID: 32546184 PMCID: PMC7298776 DOI: 10.1186/s13018-020-01743-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 06/04/2020] [Indexed: 11/20/2022] Open
Abstract
Background Spinal cord injury without radiographic abnormality (SCIWORA) is a rare traumatic myelopathy. Although surgery is one of the most important treatments, the surgery for SCIWORA is controversial, especially the time of surgery is a topic of controversy. Here, we investigate the effects of difference in duration from injury to surgery on the outcome of SCIWORA. Methods This retrospective study was performed in all patients with spinal cord injury admitted to the Third Affiliated Hospital of Hebei Medical University from January 2013 to April 2017. Fifty-seven patients who met the study requirements were divided into 3 groups according to the duration from injury to surgery. Group A (surgery within 3 days of injury) had 18 patients, group B (surgery within 3–7 days) had 18 patients, and group C (surgery later than 7 days) had 21 patients. All the groups were compared with Mann–Whitney U test; the functional improvement of spinal cord was compared and analyzed using the ASIA sports score and ASIA Impairment Scale (AIS). Results There was a significant improvement in the long-term AIS (final follow-up) in all the 3 groups compared to before surgery. The final follow-up recovery rate of group C was worse than group A and group B. The curative effect of operation within 7 days was significantly better than the surgery done 7 days later. The recovery rate of group C was worse than group A and B. The ASIA sports score showed that recovery was quicker in the early stage and slow in the later stage. Conclusions The optimal schedule of surgical treatment was 3–7 days after injury, which can significantly improve the short-term and long-term follow-up effects. Longer the time to surgery from the time of injury, the worse was the prognosis.
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Affiliation(s)
- Can Qi
- Department of Orthopedics, The Third Affiliated Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Hehuan Xia
- Department of Orthopedics, The Third Affiliated Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Dechao Miao
- Department of Spinal Surgery, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xingui Wang
- Department of Orthopedics, The Third Affiliated Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Zengyan Li
- Department of Orthopedics, The Third Affiliated Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
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Brauge D, Plas B, Vinchon M, Charni S, Di Rocco F, Sacko O, Mrozek S, Sales de Gauzy J. Multicenter study of 37 pediatric patients with SCIWORA or other spinal cord injury without associated bone lesion. Orthop Traumatol Surg Res 2020; 106:167-171. [PMID: 31786134 DOI: 10.1016/j.otsr.2019.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 08/28/2019] [Accepted: 10/01/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pure traumatic spinal cord injury (without associated bone lesion) are encountered in pediatric accidentology, the most typical being spinal cord injury without radiological abnormality (SCIWORA). The present study reports a multicenter series of under-18-year-olds admitted for traumatic medullary lesion. The objectives were: (1) to describe the causes of pure spinal cord injuries in children in France and their clinical presentation; (2) to identify any prognostic factors; and (3) to describe their medical management in France. PATIENTS AND METHOD A multicenter retrospective study was conducted in 3 pediatric spine pathology reference centers. Files of 37 patients with confirmed spinal cord injury between January 1988 and June 2017 were analyzed: SCIWORA (n=30), myelopathy associated with severe cranial trauma (n=2), and obstetric trauma (n=5). Accident causes, associated lesions, initial Frankel grade, level of clinical spinal cord injury, initial MRI findings, type of treatment and neurology results at last follow-up were collated. The main endpoint was neurologic recovery, defined by improvement of at least 1 Frankel grade. RESULTS Causes comprised 17 road accidents, 11 sports accidents, 5 obstetric lesions and 4 falls. Mean follow-up was 502 days. The rate of at least partial neurologic recovery was 20/30 in SCIWORA, 0/5 in obstetric trauma, and 0/4 in case of associated intracranial lesion. In SCIWORA, factors associated with recovery comprised age, accident type, and absence of initial MRI lesion. DISCUSSION We report a large series of pediatric spinal cord injury without associated bone lesion. This is a potentially serious pathology, in which prognosis is mainly related to age and trauma mechanism. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- David Brauge
- Pôle neuroscience - neurochirurgie (neuroscience - neurosurgery cluster), faculté de médecine (faculty of medicine), hôpital de Purpan (Purpan hospital), 31059 Toulouse, France; Arts et métier ParisTech, institut de biomécanique humaine George Charpak (Institute of human biomechanics), 75013 Paris, France.
| | - Benjamin Plas
- Pôle neuroscience - neurochirurgie (neuroscience - neurosurgery cluster), faculté de médecine (faculty of medicine), hôpital de Purpan (Purpan hospital), 31059 Toulouse, France
| | - Mathieu Vinchon
- Service de neurochirurgie (Department of neurosurgery), hôpital universitaire Roger Salengro (university hospital), 59037 Lille, France
| | - Saloua Charni
- Pôle neuroscience - neurochirurgie (neuroscience - neurosurgery cluster), faculté de médecine (faculty of medicine), hôpital de Purpan (Purpan hospital), 31059 Toulouse, France
| | - Federico Di Rocco
- Service de neurochirurgie pédiatrique (Department of pediatric neurosurgery), hôpital femme mère-enfant (Women, mother, child hospital), hospice civil de Lyon (Lyon hospitals), 69003 Lyon, France
| | - Oumar Sacko
- Pôle neuroscience - neurochirurgie (neuroscience - neurosurgery cluster), faculté de médecine (faculty of medicine), hôpital de Purpan (Purpan hospital), 31059 Toulouse, France
| | - Ségolène Mrozek
- Service d'anesthésie réanimation (Department of anesthesiology and critical care), faculté de médecine (faculty of medicine), hôpital de Purpan (Purpan hospital), 31059 Toulouse, France
| | - Jérôme Sales de Gauzy
- Service de chirurgie orthopédique et traumatologique (Department of orthopedic and trauma surgery), hôpital des enfants (Children's hospital), hôpital universitaire (university hospital), 31059 Toulouse, France
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Liang QC, Yang B, Song YH, Gao PP, Xia ZY, Bao N. Real spinal cord injury without radiologic abnormality in pediatric patient with tight filum terminale following minor trauma: a case report. BMC Pediatr 2019; 19:513. [PMID: 31870344 PMCID: PMC6927174 DOI: 10.1186/s12887-019-1894-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/17/2019] [Indexed: 11/10/2022] Open
Abstract
Background Spinal cord injury without radiographic abnormality (SCIWORA) is defined as having “clinical symptoms of traumatic myelopathy with no radiographic or computed tomographic features of spinal fracture or instability”. The mechanism of pediatric SCIWORA following minor trauma is still unclear. Tight filum terminale (TFT) has been studied in the literature, but the information regarding the predisposing factor for SCIWORA is still being defined. Case presentation We report three cases of thoracic and lumber SCIWORA with TFT. The trauma was potentially mild in all cases but resulted in catastrophic damage of the cord. All patients had no signs or symptoms of tethered cord syndrome prior to the minor trauma. TFT was found during operation. Conclusions We suggest that TFT might be a predisposing factor for SCIWORA and chronic spinal cord traction play an important role in the mechanism of pediatric thoracic and lumber SCIWORA following minor trauma. Patients who never undergo treatment for TFT likely have an elevated risk of developing SCIWORA following minor trauma.
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Affiliation(s)
- Qin Chuan Liang
- Department of Neurosurgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Dongfang Road 1678, Shanghai, 200127, China
| | - Bo Yang
- Department of Neurosurgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Dongfang Road 1678, Shanghai, 200127, China
| | - Yun Hai Song
- Department of Neurosurgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Dongfang Road 1678, Shanghai, 200127, China
| | - Pin Pin Gao
- Department of Neurosurgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Dongfang Road 1678, Shanghai, 200127, China
| | - Ze Yang Xia
- Department of Neurosurgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Dongfang Road 1678, Shanghai, 200127, China
| | - Nan Bao
- Department of Neurosurgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Dongfang Road 1678, Shanghai, 200127, China.
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Canosa-Hermida E, Mora-Boga R, Cabrera- Sarmiento J, Ferreiro-Velasco M, Salvador-de la Barrera S, Rodríguez-Sotillo A, Montoto-Marqués A. Epidemiology of traumatic spinal cord injury in childhood and adolescence in Galicia, Spain: report of the last 26-years. J Spinal Cord Med 2019; 42:423-429. [PMID: 29058557 PMCID: PMC6776227 DOI: 10.1080/10790268.2017.1389836] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To analyze the characteristics of traumatic spinal cord injury in children of Galicia (Spain). DESIGN Descriptive and retrospective study. METHODS Data extracted from the internal registry of the Spinal Cord Injury Unit and the patient's medical records, between March 1988 and December 2014. Inclusion criteria: patients aged ≤ 17 years with a traumatic spinal cord injury. UNLABELLED Outcome measures: Total patients, percentages, incidence, ASIA scale results and improvement. RESULTS A total of 68 patients were included. The incidence was 5.6 cases/1,000,000 inhabitants/year. The mean age was 14.4 years (median: 16). Only 25% were younger than 15. Male patients accounted for 73.5% of the total. The main cause were traffic accidents (60.3%; n = 41), being higher (77.8%) in children ≤ 10 years. Other etiologies included falls (19.1%), diving accidents (16.2%) and other causes (4.4%). Eleven patients (16.2%) had injuries classified as SCIWORA, 8 (72.7%) of them aged ≤ 10 years. The mean age of the SCIWORA group was 7.5 years versus 15.7 years in the non-SCIWORA group (P < 0.001). Half (50%) of these patients had a complete spinal cord injury and, of these, 64.6% were paraplegic. CONCLUSIONS Traumatic spinal cord injuries are rare in children, and most cases occur between 15 and 17 years. Unlike in adults, SCIs in children mostly involve the thoracic spine. Most patients aged ≤ 10 years have SCIWORA. The most common etiology continues to be traffic accidents, although sports accidents prevail among adolescent patients.
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Affiliation(s)
- E. Canosa-Hermida
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC). Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain,Servicio de Medicina Física y Rehabilitación, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain,Correspondence to: Eva Canosa Hermida, Complexo Hospitalario Universitario A Coruña (CHUAC), Coruña, Spain, St. Xubias de Arriba, 84 -15006 – A Coruña. E-mail:
| | - R. Mora-Boga
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC). Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain,Servicio de Medicina Física y Rehabilitación, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - J.J. Cabrera- Sarmiento
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC). Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain,Servicio de Medicina Física y Rehabilitación, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - M.E. Ferreiro-Velasco
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC). Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | - S. Salvador-de la Barrera
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC). Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | - A. Rodríguez-Sotillo
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC). Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | - A. Montoto-Marqués
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC). Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain,Departamento de Medicina, Universidade da Coruña (UDC), A Coruña, Spain
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Sakti YM, Saputra MA, Rukmoyo T, Magetsari R. Spinal cord injury without radiological abnormality ( SCIWORA) manifested as self-limited brown-SEQUARD syndrome. Trauma Case Rep 2018; 18:28-30. [PMID: 30533479 PMCID: PMC6260453 DOI: 10.1016/j.tcr.2018.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction Combination between SCIWORA and Brown-Sequard syndrome in a patient is a rare condition. In SCIWORA, there is usually a delay in neurologic deficits which can potentially lead to misdiagnosis. Therefore, the clinician should have a good understanding of the course of the disease to make a good diagnosis and treatment. Case report Reporting a case of female 20 years old with chief complaint of severe neck pain and delayed limbs weakness. The mechanism of injury was fall with the head hit the ground in left lateral flexion position. The physical examination showed zero motor power of the right limbs and contralateral pain and temperature deficit 1 h after the injury. We diagnosed the patient with incomplete spinal cord injury at C4 level with associated Brown-Sequard syndrome. We gave soft collar neck for immobilization, medication with NSAID for analgetic and Methylprednisolon. We found dramatic improvement in 10 h after the injury with motor improvement from 0 to 5 and normal sensory function. The patient then was discharged with good functional outcome and with no sequelae. Conclusion Incomplete cervical spinal cord injury without radiological abnormality that manifested as Brown-Sequard syndrome is a rare case and potentially confusing condition. Better understanding of the course of the disease may help the clinician to make a right diagnosis and plan for management.
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Affiliation(s)
- Y M Sakti
- Gadjah Mada University, Sardjito Hospital, Yogyakarta, Indonesia
| | - M A Saputra
- Gadjah Mada University, Sardjito Hospital, Yogyakarta, Indonesia
| | - T Rukmoyo
- Gadjah Mada University, Sardjito Hospital, Yogyakarta, Indonesia
| | - R Magetsari
- Gadjah Mada University, Sardjito Hospital, Yogyakarta, Indonesia
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20
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Copley PC, Tilliridou V, Kirby A, Jones J, Kandasamy J. Management of cervical spine trauma in children. Eur J Trauma Emerg Surg 2019; 45:777-89. [PMID: 30167742 DOI: 10.1007/s00068-018-0992-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 08/16/2018] [Indexed: 12/11/2022]
Abstract
Purpose Paediatric cervical spine injuries are fortunately a rare entity. However, they do have the potential for devastating neurological sequelae with lifelong impact on the patient and their family. Thus, management ought to be exceptional from the initial evaluation at the scene of the injury, through to definitive management and rehabilitation. Methods We set out to review cervical spine injuries in children and advise on current best practice with regards to management. Results Epidemiology, initial management at the scene of injury, radiological findings and pitfalls of cervical spine trauma are outlined. Strategies for conservative and surgical management are detailed depending on the pattern of injury. The management of spinal cord injuries without radiological abnormality (SCIWORA) and cranio-cervical arterial injuries is also reviewed. Conclusions Due to a paucity of evidence in these rare conditions, expert opinion is necessary to guide best practice management and to ensure the best chance of a good outcome for the injured child.
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Asan Z. Spinal Concussion in Adults: Transient Neuropraxia of Spinal Cord Exposed to Vertical Forces. World Neurosurg 2018; 114:e1284-e1289. [PMID: 29626691 DOI: 10.1016/j.wneu.2018.03.198] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of the study is to discuss along with literature knowledge the post-traumatic clinical progression of cases with symptoms of transient spinal cord impact and cases of spinal concussion following exposure of the vertebral column to vertical forces. MATERIALS AND METHODS A total of 43 cases, all falls from height, were diagnosed with spinal concussion. It was determined that the vertebral column had been exposed to the effects of vertical forces, and the spinal cord had been affected by vertical forces. In all cases, spinal magnetic resonance imaging and dynamic X-ray examinations were performed at the time of admission. Clinical symptoms of the cases were recorded by scoring based on the Torg Grading System. RESULTS Cases were started on conservative treatment because radiologic symptoms that would explain the clinical symptoms could not be detected. Most frequently encountered were the neurologic symptoms related to the upper thoracic and lower cervical segments being affected. In 7 cases, urinary incontinence was also detected. Symptoms related to the spinal cord being affected were completely recovered in 1-3 days in all cases. CONCLUSION As a result of the vertebral column being affected by vertical forces, the most frequently affected are the thoracic segments of the spinal cord. These cases show similarities to real spinal cord injury without radiographic abnormality cases when evaluated along with clinical and radiologic symptoms. Absolute differential diagnosis from real spinal cord injury without radiographic abnormality cases cannot be made until total neurologic recovery takes place.
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Affiliation(s)
- Ziya Asan
- Department of Neurosurgery, Faculty of Medicine, Ahi Evran University, Kirsehir, Turkey.
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Shimizu EN, Seifert JL, Johnson KJ, Romero-Ortega MI. Prophylactic Riluzole Attenuates Oxidative Stress Damage in Spinal Cord Distraction. J Neurotrauma 2018; 35:1319-1328. [PMID: 29295647 DOI: 10.1089/neu.2017.5494] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Spinal cord injury (SCI) without radiographical abnormalities (SCIWORA) presents a significant challenge because of the loss of function despite an apparent normal anatomy. The cause of dysfunction is not understood, and specific treatment options are lacking. Some scoliosis corrective surgeries result in SCIWORA, where stretching of the spinal cord can lead to vascular compromise and hypoxia. The iatrogenic nature of this injury allows for the implantation of neuroprotective strategies that are designed to prevent damage. We utilized a model of atraumatic SCI to evaluate the efficacy of the sodium-channel blocker, riluzole, as a prophylactic neuroprotectant. As expected, the stretch injury caused a significant reduction in intraparenchymal oxygen in distraction (-53.09 ± 22.23%) and riluzole pre-treated distraction animals (-43.04 ± 22.86%). However, in contrast to the oxidative stress and metabolic impairments observed in vehicle-treated distraction animals, in which protein carbonylation increased significantly (5.88 ± 1.3 nmol/mL), riluzole kept these levels within the normal range (1.8 ± 1.0 nmol/mL). This neurprotection also prevented ventral motor neuron hypoplasia and pyknosis, characteristic features of this atraumatic SCI model, and maintained normal gait function (e.g., stride length and stance time). This study provides evidence for the use of prophylactic neuroprotective strategies in which thoracic or spine surgeries present the risk of causing atraumatic SCI.
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Affiliation(s)
- Eileen N Shimizu
- 1 Bioengineering Department, University of Texas at Dallas , Richardson, Texas
| | - Jennifer L Seifert
- 1 Bioengineering Department, University of Texas at Dallas , Richardson, Texas
| | - Kevin J Johnson
- 1 Bioengineering Department, University of Texas at Dallas , Richardson, Texas
| | - Mario I Romero-Ortega
- 1 Bioengineering Department, University of Texas at Dallas , Richardson, Texas.,2 Surgery Department, University of Texas Southwestern Medical Center , Dallas, Texas
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Ren J, Zeng G, Ma YJ, Chen N, Chen Z, Ling F, Zhang HQ. Pediatric thoracic SCIWORA after back bend during dance practice: a retrospective case series and analysis of trauma mechanisms. Childs Nerv Syst 2017; 33:1191-1198. [PMID: 28378287 DOI: 10.1007/s00381-017-3407-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 03/29/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of the study was to describe a unique type of low-energy traumatic pediatric thoracic spinal cord injury without radiographic abnormality (SCIWORA) after a back bend during dance practice and analyze the trauma mechanisms and treatment protocols. METHODS This was a retrospective case series from September 2007 to August 2016. The study was conducted at a tertiary medical center in Beijing, China (Xuanwu Hospital, China International Neuroscience Institute [China-INI], Capital Medical University). A total of 12 pediatric patients who had a clear traumatic history after back bend movements and had been diagnosed with thoracic SCIWORA were included. Clinical and imaging data were obtained for each patient. The follow-up data was analyzed. The traumatic mechanisms were investigated by analyzing the patients' medical history, spinal diffusion tensor imaging (DTI) and fiber tractography data. RESULTS Of the 12 patients, 11 (91.7%) were younger than 8 years old. The mean age of the patients was 6.6 years. All patients had a clear traumatic history of severe thoracic spinal cord injury after performing back bend movements. The mean follow-up time was 36.5 months. During the follow-up period, 1 patient (8.3%) recovered completely, and 11 patients (91.7%) had unfavorable prognoses, including 4 (33.3%) with incomplete recovery and 7 (58.3%) with no change. Two patients underwent spinal DTI, which showed rupture of the nerve fiber bundle in the section of the injury. CONCLUSIONS Back bend movements performed during dance practice may cause pediatric thoracic SCIWORA, particularly in children younger than 8 years old. We suggest that the mechanism of primary injury is the longitudinal distraction of the thoracic spine during back bend movements, which leads to violent distraction of the spinal cord and blunt injury of nerve axons, nerve cells, and small vessels. Spinal DTI may facilitate the diagnosis and prognostic evaluation of SCIWORA.
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Affiliation(s)
- Jian Ren
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, 100053, China
| | - Gao Zeng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, 100053, China
| | - Yong-Jie Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, 100053, China
| | - Nan Chen
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Zan Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, 100053, China
| | - Feng Ling
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, 100053, China
| | - Hong-Qi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, 100053, China.
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Jiang X, Chen D, Lou Y, Li Z. Kinematic analysis of cervical spine canal diameter and its association with grade of degeneration. Eur Spine J 2016; 25:2166-72. [PMID: 27236657 DOI: 10.1007/s00586-016-4624-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 05/22/2016] [Accepted: 05/22/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To investigate the cervical spinal canal diameters variance under positional MRI, and also the relationship between cervical canal diameter variance rate and grade of degeneration. METHODS From January 2013 to January 2015, a consecutive of 273 symptomatic patients (166 males and 207 females) with an average age of 44.6 years (range 21-89 years) underwent positional cervical MRI. T2-weighted sagittal images of 1638 cervical intervertebral discs from 273 subjects were classified into five grades. The canal diameter and canal diameter variance rate at three positions and their comparison among five grade of degeneration were evaluated. The measurements were tabulated and analyzed using SPSS. 13.0. p values less than 0.05 were considered to indicate a statistically significant difference. RESULTS The sagittal cervical canal diameter at the C5/6 level were the smallest compared with the other levels regardless of neutral, flexion or extension positions, C5/6 level had the largest canal diameter variance rate in both flexion and extension (8.14 ∓ 0.38 and 7.81 ∓ 0.31 %, respectively), second was C4/5 level (7.65 ∓ 0.39 and 7.67 ∓ 0.32 %, respectively). A total of 1638 discs were classified into 5 groups, each level showed the similar tendency that no matter what position, with the increasing grade of degenerative disc degree, spine canal diameter decreased gradually. For C5/6 under extension and flexion position, significant difference was also noted between grade 2 and 3; For C4/5 under extension position, significant difference existed between grade 1 and 2, grade 1 and 3, while under flexion position, significant difference existed between grade 2 and 4, and the results also showed no significant difference at the same degree of degeneration on both levels between extension and flexion position. CONCLUSIONS C5/6 and C4/5 is of higher risk of suffering SCI than other levels, C4/5 level predispose SCI at earlier stage than C5/6, patients presenting with intermediate signal and slight decreased disc height on T2 weighted MRI at C4/5 level should be paid attention.
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Fiaschi P, Severino M, Ravegnani GM, Piatelli G, Consales A, Accogli A, Capra V, Cama A, Pavanello M. Idiopathic Cervical Hematomyelia in an Infant: Spinal Cord Injury without Radiographic Abnormality Caused by a Trivial Trauma? Case Report and Review of the Literature. World Neurosurg 2016; 90:38-44. [PMID: 26899465 DOI: 10.1016/j.wneu.2016.01.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/22/2016] [Accepted: 01/23/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Spontaneous or idiopathic intramedullary bleeding is a very rare event in pediatric patients. This diagnosis requires an extended clinical, laboratory, and radiologic work-up to rule out all potential causes of hematomyelia. However, children may present with hematomyelia or spinal cord injury without radiographic abnormality even after a minor trauma. CASE DESCRIPTION A 15-month-old girl presented with a 24-hour history of progressive neurologic deficits. A trivial trauma had occurred a few days before the clinical onset. Head computed tomography scan and craniospinal magnetic resonance imaging revealed an isolated hemorrhagic central medullary lesion extending from the obex to C3 level. No underlying causes of intramedullary bleeding were identified. In the absence of obvious vascular abnormalities, the patient underwent an urgent occipitocervical decompression with hematoma evacuation. Postoperatively, the patient's motor symptoms rapidly resolved, and she was discharged with cervical collar immobilization. CONCLUSIONS We discuss the differential diagnosis of intramedullary bleeding in children, focusing on the diagnostic protocol and therapeutic options in this age group.
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Affiliation(s)
- Pietro Fiaschi
- Department of Neurosurgery, IRCCS San Martino-IST University Hospital, Genoa, Italy.
| | | | | | | | | | - Andrea Accogli
- Neurosurgery Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Valeria Capra
- Neurosurgery Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Armando Cama
- Neurosurgery Unit, Istituto Giannina Gaslini, Genoa, Italy
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Abstract
OBJECT In the US, race and economic status have pervasive associations with mechanisms of injury, severity of injury, management, and outcomes of trauma. The goal of the current study was to examine these relationships on a large scale in the setting of pediatric spinal injury. METHODS Admissions for spinal fracture without or with spinal cord injury (SCI), spinal dislocation, and SCI without radiographic abnormality were identified in the Kids' Inpatient Database (KID) and the National Trauma Data Bank (NTDB) registry for 2009. Patients ranged in age from birth up to 21 years. Data from the KID were used to estimate nationwide annual incidences. Data from the NTDB were used to describe patterns of injury in relation to age, race, and payor, with corroboration from the KID. Multiple logistic regression was used to model rates of mortality and spinal fusion. RESULTS In 2009, the estimated incidence of hospital admission for spinal injury in the US was 170 per 1 million in the population under 21 years of age. The incidence of SCI was 24 per 1 million. Incidences varied regionally. Adolescents predominated. Patterns of injury varied by age, race, and payor. Black patients were more severely injured than patients of other races as measured by Injury Severity Scale scores. Among black patients with spinal injury in the NTDB, 23.9% suffered firearm injuries; only 1% of white patients suffered firearm injuries. The overall mortality rate in the NTDB was 3.9%. In a multivariate analysis that included a large panel of clinical and nonclinical factors, black race retained significance as a predictor of mortality (p = 0.006; adjusted OR 1.571 [1.141-2.163]). Rates of spinal fusion were associated with race and payor in the NTDB data and with payor in the KID: patients with better insurance underwent spinal fusion at higher rates. CONCLUSIONS The epidemiology of pediatric spinal injury in the US cannot be understood apart from considerations of race and economic status.
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Affiliation(s)
- Joseph H Piatt
- Nemours Neuroscience Center, AI duPont Hospital for Children, Wilmington, Delaware; and Departments of Neurological Surgery and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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Zhang JD, Xia Q. Role of Intraoperative Disc Contrast Injection in Determining the Segment Responsible for Cervical Spinal Cord Injury without Radiographic Abnormalities. Orthop Surg 2015; 7:239-43. [PMID: 26311098 DOI: 10.1111/os.12197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/02/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To determine the features of discs in spinal cord injury without radiographic abnormality (SCIWORA) by intraoperative disc contrast injection (IODCI) and to subsequently treat the responsible discs operatively. METHODS From January 2007 to December 2011, 16 adult cases of cervical SCIWORA were enrolled in this study. The average preoperative Japanese Orthopaedic Association (JOA) score was 9.1 ± 1.8. Although preoperative imaging showed no obvious fracture or dislocation, spinal cord compression was evident in all cases. High spinal cord signals on MRI T2WI and cervical disc degeneration were present in all cases and swollen soft tissue anterior to the cervical spine in nine cases. All patients underwent anterior cervical surgeries for spinal cord compression, IODCI being performed after exposure of suspicious discs. Patients with only one ruptured disc underwent anterior cervical discectomy and fusion; those with more complex injuries underwent anterior cervical corpectomy and fusion with fixation of the ruptured segment. JOA scores, X-rays and CT scans were checked at specified intervals over an average of 24.4 months. RESULTS Of 32 discs suspected preoperatively of being injured, 19 were identified as ruptured by IODCI. Anterior annulus fibrosus rupture was proved in 11 patients whereas the anterior longitudinal ligament was intact in all. JOA scores at 2 weeks, 3 months and last follow-up postoperatively were 13.3 ± 1.5, 14.5 ± 1.6 and 15.1 ± 1.5 respectively. The recovery rates were 53.2%, 68.3% and 75.9%, respectively. CONCLUSION IODCI helps to determine the segment responsible for cervical SCIWORA.
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Affiliation(s)
- Ji-dong Zhang
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
| | - Qun Xia
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
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Abstract
BACKGROUND Patients with spinal cord injury without radiographic abnormality (SCIWORA) are prone to develop spinal deformities. The purpose of this study is to report on the clinical and radiological features of post-SCIWORA spinal deformities. METHODS Four patients with SCIWORA and spinal deformities requiring surgery were analyzed clinically and radiographically. RESULTS All four SCIWORA patients developed progressive neuromuscular scoliosis. There were 2 males and 2 females. The mean age at spinal cord injury was 3.9 years (range 6 months to 7 years). Spinal deformity was first noticed at a mean of 17 months after their initial injury (range 9 months to 2 years), and surgical intervention was performed at a mean of 6.5 years following their injury (range 4-11 years). The mean preoperative curve was 54° (range 50-62°). The mean postoperative curve was 9.5° (range 5-16°). The level of injury was T5 in two patients, and T10 and L2 in one patient each. All but the lumbar level injury patient had complete paraplegia. One patient with complete injury (T10) and another with incomplete injury (L2) improved neurologically and were able to walk with the aid of orthoses and crutches. Pelvic obliquity improved in all patients following spinal reconstruction surgery, and none of the patients required additional surgery for spinal deformity. The mean postoperative follow-up was 51.75 months (range 24-93 months). CONCLUSIONS Long scoliotic curves extending to the pelvis should be expected in SCIWORA. Early intervention may prevent severe deformities. Modern instrumentation techniques employing pedicle screws provided satisfactory correction, improved hip subluxation, and did not adversely affect the ambulatory ability or functional level of the patients in this series.
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Affiliation(s)
- Nadir Yalcin
- />Department of Orthopaedics and Traumatology, Ataturk Education and Research Hospital, Bilkent, Ankara, Turkey
| | - Ozgur Dede
- />Orthopaedic Surgery and Traumatology Department, Hacettepe University, Sihhiye, Ankara, Turkey
| | - Ahmet Alanay
- />Faculty of Medicine, Department of Orthopaedics and Traumatology, Istanbul Spine Center, Florence Nightingale Hospital, Bilim University, Abide-i Hürriyet cad. No 290, 34403 Sisli, Istanbul, Turkey
| | - Muharrem Yazici
- />Orthopaedic Surgery and Traumatology Department, Hacettepe University, Sihhiye, Ankara, Turkey
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