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Moses J, Hach S, Mason J, Treacher A. Defining and measuring objective and subjective spinal stiffness: a scoping review. Disabil Rehabil 2023; 45:4489-4502. [PMID: 36516462 DOI: 10.1080/09638288.2022.2152878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/24/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Examine and identify the breadth of definitions and measures of objective and subjective spinal stiffness in the literature, with a focus on clinical implications. METHODS A scoping review was conducted to determine what is known about definitions and measures of the specific term of spinal stiffness. Following the framework by Arksey and O'Malley, eligible peer-reviewed studies identified using PubMed, Ebsco health, and Scopus were included if they reported definitions or measures of spinal stiffness. Using a data abstraction form, the studies were classified into four themes: biomechanical, surgical, pathophysiological, and segmental spinal assessment. To identify similarities and differences between studies, sixteen categories were generated. RESULTS In total, 2426 records were identified, and 410 met the eligibility criteria. There were 350 measures (132 subjective; 218 objective measures) and 93 indicators of spinal stiffness. The majority of studies (n = 69%) did not define stiffness. CONCLUSION This review highlights the breadth of objective and subjective measures that are both clinically and methodologically diverse. There is no consensus regarding a standardised definition of stiffness in the reviewed literature.
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Affiliation(s)
- Joel Moses
- Private Practice, Cambridge, New Zealand
| | - Sylvia Hach
- School of Community Studies, Unitec Institute of Technology, Auckland, New Zealand
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Yadav CP, Dhakal S, Bhattarai HB, Bhattarai M, Lamichhane S, Singh I, Subedi P. Traumatic retroclival hematoma complicated with hyponatremia and delayed traumatic intracranial hematoma in an adult: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231178400. [PMID: 37325171 PMCID: PMC10265364 DOI: 10.1177/2050313x231178400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 05/10/2023] [Indexed: 06/17/2023] Open
Abstract
Intracranial hematoma is a common variety of brain insults in trauma. However, posterior fossa hematoma in the retroclival location is quite unusual. There are limited numbers of case reports regarding traumatic retroclival hematoma. Some are managed with surgery in this condition. We present a traumatic retroclival hematoma in a 34-year-old gentleman who sustained brain trauma in a motor vehicle accident. His condition was further complicated by hyponatremia and delayed traumatic intracerebral hematoma in a distant location. The only symptom he had later was severe headache which could be attributed to delayed traumatic intracerebral hematoma and hyponatremia. He was managed conservatively and discharged on the 12th day from the hospital.
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Affiliation(s)
| | - Sudan Dhakal
- Department of Neurosurgery, Annapurna Neurological Institute & Allied Sciences, Kathmandu, Nepal
| | | | | | - Saral Lamichhane
- Gandaki Medical College Teaching Hospital & Research Center, Pokhara, Nepal
| | - Ishani Singh
- Kathmandu Medical College, Teaching Hospital and Research Center, Kathmandu, Nepal
| | - Prativa Subedi
- KIST Medical College & Teaching Hospital, Lalitpur, Nepal
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Khormi YH. Retroclival hematomas in adult patients: A systematic review of a rare intracranial hematoma. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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A rare case of retroclival epidural hematoma: case report and review of the literature. Acta Neurol Belg 2021; 121:509-513. [PMID: 31721055 DOI: 10.1007/s13760-019-01238-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
Retroclival epidural hematomas (REDHs) are rare and almost exclusively found in the pediatric age group. Frequently, the etiology is related to accidental trauma, though other mechanisms have been observed, including coagulopathy, non-accidental trauma, and pituitary apoplexy. A 76-year-old man was admitted to our emergency department after a loss of consciousness. He presented with a Glasgow Coma Scale of 13(E3V4M6). He complained of headache accompanied by nausea and vomiting. A computer tomography (CT) revealed a hemorrhage along the clivus and dens. Magnetic resonance imaging (MRI) demonstrated the retroclival hematoma in epidural space. At discharge headache resolved without medical or operative intervention. REDHs are likely underdiagnosed in adults and magnetic resonance imaging is superior for identifying these lesions. Atlanto-occipital dislocation should be considered in all cases of REDH. Most cases exhibit a benign clinical course with conservative management, surgical management is dictated based on the presence of hydrocephalus, brainstem compression, and occipitocervical instability.
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Caglar YS, Erdogan K, Kilinc CM, Mammadkhanli O, Ozgural O, Eroglu U. Retroclival epidural hematoma: A rare location of epidural hematoma, case report, and review of literature. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2020; 11:342-346. [PMID: 33824566 PMCID: PMC8019111 DOI: 10.4103/jcvjs.jcvjs_97_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/20/2020] [Indexed: 11/10/2022] Open
Abstract
Retroclival epidural hematoma in adults is uncommon. Although most cases are associated with craniocervical trauma, other mechanisms have been reported, such as coagulopathy, vascular lesions, and pituitary apoplexy. We report two adults diagnosed with retroclival epidural hematoma. One patient was an 89-year-old male with leukemia and thrombocytopenia who sustained a fall and developed a traumatic retroclival epidural hematoma with brainstem compression; surgery could not be performed due to his clinical condition and he died 5 days later. The other patient was a 78-year-old female with atrial fibrillation who developed a spontaneous retroclival epidural hematoma as a result of warfarin use; she was treated conservatively with anticoagulant reversal and methylprednisolone and was subsequently discharged without neurological deficit. Retroclival hematomas are primarily treated conservatively due to the difficulty of surgical approach. The bleeding mechanism and dural and venous anatomy of this region tend to limit hematoma expansion.
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Affiliation(s)
- Yusuf Sukru Caglar
- Department of Neurosurgery, Ibn-i Sina Hospital, Ankara University, Ankara, Turkey
| | - Koral Erdogan
- Department of Neurosurgery, Ibn-i Sina Hospital, Ankara University, Ankara, Turkey
| | - Cemil Mustafa Kilinc
- Department of Neurosurgery, Ibn-i Sina Hospital, Ankara University, Ankara, Turkey
| | | | - Onur Ozgural
- Department of Neurosurgery, Ibn-i Sina Hospital, Ankara University, Ankara, Turkey
| | - Umit Eroglu
- Department of Neurosurgery, Ibn-i Sina Hospital, Ankara University, Ankara, Turkey
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Solorio-Pineda S, Nieves-Valerdi AA, Franco-Jiménez JA, Gutiérrez-Aceves GA, Buenrostro-Torres LM, Ruíz-Flores MI. Retroclival and spinal subdural hematoma after traumatic brain injury - A case report and literature review. Surg Neurol Int 2019; 10:86. [PMID: 31528424 PMCID: PMC6744770 DOI: 10.25259/sni-11-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/07/2019] [Indexed: 11/04/2022] Open
Abstract
Background Retroclival hematomas are rare and occur mostly in the pediatric population. They are variously attributed to trauma, apoplexy, and vascular lesions. With motor vehicle accidents (MVAs), the mechanism of traumatic injury is forced flexion and extension. There may also be associated cervical spinal and/or clivus fractures warranting fusion. Case Description A 35-year-old male sustained a traumatic brain injury after a fall of 5 m at work. His Glasgow coma scale (GCS) on admission was 13 (M6V3O4). He had no cranial nerve deficits. The brain computed tomography (CT) showed a retroclival subdural hematoma that extended to the C2 level. Conclusions Most retroclival hematomas are attributed to MVAs, and cranial CT and magnetic resonance studies typically demonstrate a combination of posterior fossa hemorrhage with retroclival hematomas (intra or extradural). Patients with retroclival hematomas but high GCS scores on admission usually have better prognoses following traumatic brain injuries attributed to MVA. Notable however is the frequent association with additional cervical and/or craniocervical injuries (e.g. such as odontoid fracture) that may warrant surgery/fusión.
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Affiliation(s)
- Saúl Solorio-Pineda
- Department of Neurosurgery, Centro Médico "Lic. Adolfo López Mateos", ISEM. Av Nicolás San Juan S/N, Colonia ex-Hacienda la Magdalena, Toluca, Estado de México, México
| | - Adriana Ailed Nieves-Valerdi
- Department of Neurosurgery, Centro Médico "Lic. Adolfo López Mateos", ISEM. Av Nicolás San Juan S/N, Colonia ex-Hacienda la Magdalena, Toluca, Estado de México, México
| | - José Alfonso Franco-Jiménez
- Department of Neurosurgery, Centro Médico "Lic. Adolfo López Mateos", ISEM. Av Nicolás San Juan S/N, Colonia ex-Hacienda la Magdalena, Toluca, Estado de México, México
| | - Guillermo Axayacalt Gutiérrez-Aceves
- Department of Neurosurgery, Centro Médico "Lic. Adolfo López Mateos", ISEM. Av Nicolás San Juan S/N, Colonia ex-Hacienda la Magdalena, Toluca, Estado de México, México.,Radioneurosurgery Unit, Neurological Center, Department of Neurosurgery, National Institute of Neurology and Neurosurgery "Dr. Manuel Velasco Suarez", Av. Insurgentes Sur No. 3877, La Fama, México.,American British Cowray Medical Center, Carlos Graef Fernández No. 154, Col. Santa Fe, Cuajimalpa, México City, México
| | - Luis Manuel Buenrostro-Torres
- Department of Neurosurgery, Centro Médico "Lic. Adolfo López Mateos", ISEM. Av Nicolás San Juan S/N, Colonia ex-Hacienda la Magdalena, Toluca, Estado de México, México
| | - Milton Inocencio Ruíz-Flores
- Department of Neurosurgery, Centro Médico "Lic. Adolfo López Mateos", ISEM. Av Nicolás San Juan S/N, Colonia ex-Hacienda la Magdalena, Toluca, Estado de México, México
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Retroclival epidural haematoma: a diagnosis to suspect. Report of three cases and review of the literature. Acta Neurochir (Wien) 2017; 159:1571-1576. [PMID: 28526902 DOI: 10.1007/s00701-017-3214-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
Abstract
Retroclival epidural haematoma (REDH) has been reported infrequently. It is a rare entity which is probably underdiagnosed. It is most commonly seen in the paediatric population and is generally associated with high-velocity injuries. We report three cases of paediatric patients diagnosed with REDHs: two of them secondary to high-energy trauma related to a motor-vehicle accident and the other a low-energy trauma after a slip while playing football. All three patients were managed conservatively by cervical immobilisation with favourable outcome. REDH is probably underdiagnosed by computed tomography scan. When the suspicion is high, sagittal reconstructions or magnetic resonance imaging should be considered to confirm the diagnosis. Usually, it is related to hyperflexion or hyperextension cervical injuries secondary to motor vehicle accident. However, it can also be observed in milder injuries.
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Isolated traumatic retroclival hematoma: case report and review of literature. Childs Nerv Syst 2016; 32:1749-55. [PMID: 27117267 PMCID: PMC5021739 DOI: 10.1007/s00381-016-3098-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 04/18/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Retroclival hematomas are a rare entity. The pathology can be categorized into epidural hematoma or subdural hematoma based on the anatomy of the tectorial membrane. Frequently, the etiology is related to accidental trauma, though other mechanisms have been observed, including coagulopathy, non-accidental trauma, and pituitary apoplexy. There have been only 2 prior cases where both epidural and subdural hematoma co-present. CASE PRESENTATION An 8-year-old male was involved in a high-speed motor vehicle accident. He presented with a Glasgow Coma Score (GCS) of 14 with bilateral abducens nerve palsies. Computed tomography (CT) revealed a hemorrhage along the dorsum sella, clivus, and dens. Magnetic resonance imaging (MRI) demonstrated the retroclival hematoma in both the subdural and epidural space. At discharge, 19 days after the accident, the abducens nerve palsies had resolved without medical or operative intervention. CONCLUSION Retroclival hematoma may present after trauma. Although most cases exhibit a benign clinical course with conservative management, significant and profound morbidity and mortality have been reported. Prompt diagnosis with close observation is prudent. Surgical management is indicated in the presence of hydrocephalus, symptomatic brainstem compression, and occipito-cervical instability.
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