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Şık N, Bulut SK, Şalbaş ÖY, Yılmaz D, Duman M. Evaluation of traumatic spinal injuries: a pediatric perspective. Childs Nerv Syst 2024:10.1007/s00381-024-06447-z. [PMID: 38856745 DOI: 10.1007/s00381-024-06447-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 05/01/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE The aim of the present study is to provide information about pediatric patients with spinal trauma. METHODS A single-center retrospective chart review was carried out. Children who arrived at the pediatric emergency department due to trauma and those with spinal pathology confirmed by radiological assessment were included. Demographics, mechanisms of trauma, clinical findings, radiological investigations, applied treatments, hospital stay and prognosis were recorded. RESULTS A total of 105 patients [59 (56.2%) boys; mean age: 12.9 ± 3.8 years (mean ± SD)] were included. The most common age group was that of 14-18 years (58.1%). The three most common trauma mechanisms were road traffic collisions (RTCs) (60.0%), falls (32.4%), and diving into water (2.9%). A fracture of the spine was detected in 97.1% patients, vertebral dislocation in 10.7%, and spinal cord injury in 16.3%. Of the patients, 36.9% were admitted to the ward and 18.4% to the pediatric intensive care unit; 17.1% were discharged with severe complications and 2.9% cases resulted in death. While 34.3% of the patients had a clinically isolated spine injury, the remaining cases entailed an injury to at least one other body part; the most common associated injuries were to the head (39.8%), abdomen (36.1%), and external areas (28.0%). CONCLUSION Spinal trauma was found to have occurred mostly in adolescent males, and the majority of those cases were due to RTCs. Data on the incidence and demographic factors of pediatric spinal trauma are crucial in furthering preventive measures, allowing for the identification of at-risk populations and treatment modalities.
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Affiliation(s)
- Nihan Şık
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Sena Kalkan Bulut
- Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Özge Yıldırım Şalbaş
- Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Durgül Yılmaz
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Murat Duman
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
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Yue X, Yu X, Wang F, Zhao D, Ma Y, Zhao H. Spinal cord injury without radiographic abnormality with diffuse idiopathic skeletal hyperostosis: A case report. Int J Surg Case Rep 2024; 119:109654. [PMID: 38678990 PMCID: PMC11063900 DOI: 10.1016/j.ijscr.2024.109654] [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: 03/17/2024] [Revised: 04/09/2024] [Accepted: 04/19/2024] [Indexed: 05/01/2024] Open
Abstract
INTRODUCTION Spinal cord injury without fracture dislocation (SCIWORA) is relatively rare, and spastic paralysis for more than 2 months with Diffuse diopathic skeletal hyperoseosis (DISH) is even rarer. CASE PRESENTATION A 70-year-old male patient presented with quadriplegia for more than 2 months after a fall. He's incontinent of stool and urine. An MRI was performed and the diagnosis was "SCIWORA, DISH". After surgical treatment, there was a significant recovery of postoperative related symptoms. CLINICAL DISCUSSION The timing of SCIWORA surgery remains controversial, with most studies suggesting that early surgery (within 24 h) is more effective. Anterior cervical discectomy and fusion (ACDF) is one of the main surgical procedures that directly and completely removes compression from the anterior aspect of the spinal cord. Patients with SCIWORA combined with DISH may have fractures due to low-energy injuries and should be treated aggressively with surgery to avoid secondary injury to the spinal cord. CONCLUSION Adult SCIWORA patients should be aggressively treated surgically when vital signs are stable and relatively calm. To avoid secondary injury, titanium plates combined with self-stabilizing fusions provide reliable immediate stabilization and can be used as one of the internal fixation modalities.
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Affiliation(s)
- Xinliang Yue
- Dongzhimen Hospital Afliated to Beijing University of Chinese Medicine, Beijing 100700, China
| | - Xing Yu
- Dongzhimen Hospital Afliated to Beijing University of Chinese Medicine, Beijing 100700, China.
| | - Fengxian Wang
- Dongzhimen Hospital Afliated to Beijing University of Chinese Medicine, Beijing 100700, China
| | - Dingyan Zhao
- Dongzhimen Hospital Afliated to Beijing University of Chinese Medicine, Beijing 100700, China
| | - Yukun Ma
- Dongzhimen Hospital Afliated to Beijing University of Chinese Medicine, Beijing 100700, China
| | - He Zhao
- Dongzhimen Hospital Afliated to Beijing University of Chinese Medicine, Beijing 100700, China
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Tavender E, Eapen N, Wang J, Rausa VC, Babl FE, Phillips N. Triage tools for detecting cervical spine injury in paediatric trauma patients. Cochrane Database Syst Rev 2024; 3:CD011686. [PMID: 38517085 PMCID: PMC10958760 DOI: 10.1002/14651858.cd011686.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
BACKGROUND Paediatric cervical spine injury (CSI) after blunt trauma is rare but can have severe consequences. Clinical decision rules (CDRs) have been developed to guide clinical decision-making, minimise unnecessary tests and associated risks, whilst detecting all significant CSIs. Several validated CDRs are used to guide imaging decision-making in adults following blunt trauma and clinical criteria have been proposed as possible paediatric-specific CDRs. Little information is known about their accuracy. OBJECTIVES To assess and compare the diagnostic accuracy of CDRs or sets of clinical criteria, alone or in comparison with each other, for the evaluation of CSI following blunt trauma in children. SEARCH METHODS For this update, we searched CENTRAL, MEDLINE, Embase, and six other databases from 1 January 2015 to 13 December 2022. As we expanded the index test eligibility for this review update, we searched the excluded studies from the previous version of the review for eligibility. We contacted field experts to identify ongoing studies and studies potentially missed by the search. There were no language restrictions. SELECTION CRITERIA We included cross-sectional or cohort designs (retrospective and prospective) and randomised controlled trials that compared the diagnostic accuracy of any CDR or clinical criteria compared with a reference standard for the evaluation of paediatric CSI following blunt trauma. We included studies evaluating one CDR or comparing two or more CDRs (directly and indirectly). We considered X-ray, computed tomography (CT) or magnetic resonance imaging (MRI) of the cervical spine, and clinical clearance/follow-up as adequate reference standards. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts for relevance, and carried out eligibility, data extraction and quality assessment. A third review author arbitrated. We extracted data on study design, participant characteristics, inclusion/exclusion criteria, index test, target condition, reference standard and data (diagnostic two-by-two tables) and calculated and plotted sensitivity and specificity on forest plots for visual examination of variation in test accuracy. We assessed methodological quality using the Quality Assessment of Diagnostic Accuracy Studies Version 2 tool. We graded the certainty of the evidence using the GRADE approach. MAIN RESULTS We included five studies with 21,379 enrolled participants, published between 2001 and 2021. Prevalence of CSI ranged from 0.5% to 1.85%. Seven CDRs were evaluated. Three studies reported on direct comparisons of CDRs. One study (973 participants) directly compared the accuracy of three index tests with the sensitivities of NEXUS, Canadian C-Spine Rule and the PECARN retrospective criteria being 1.00 (95% confidence interval (CI) 0.48 to 1.00), 1.00 (95% CI 0.48 to 1.00) and 1.00 (95% CI 0.48 to 1.00), respectively. The specificities were 0.56 (95% CI 0.53 to 0.59), 0.52 (95% CI 0.49 to 0.55) and 0.32 (95% CI 0.29 to 0.35), respectively (moderate-certainty evidence). One study (4091 participants) compared the accuracy of the PECARN retrospective criteria with the Leonard de novo model; the sensitivities were 0.91 (95% CI 0.81 to 0.96) and 0.92 (95% CI 0.83 to 0.97), respectively. The specificities were 0.46 (95% CI 0.44 to 0.47) and 0.50 (95% CI 0.49 to 0.52) (moderate- and low-certainty evidence, respectively). One study (270 participants) compared the accuracy of two NICE (National Institute for Health and Care Excellence) head injury guidelines; the sensitivity of the CG56 guideline was 1.00 (95% CI 0.48 to 1.00) compared to 1.00 (95% CI 0.48 to 1.00) with the CG176 guideline. The specificities were 0.46 (95% CI 0.40 to 0.52) and 0.07 (95% CI 0.04 to 0.11), respectively (very low-certainty evidence). Two additional studies were indirect comparison studies. One study (3065 participants) tested the accuracy of the NEXUS criteria; the sensitivity was 1.00 (95% CI 0.88 to 1.00) and specificity was 0.20 (95% CI 0.18 to 0.21) (low-certainty evidence). One retrospective study (12,537 participants) evaluated the PEDSPINE criteria and found a sensitivity of 0.93 (95% CI 0.78 to 0.99) and specificity of 0.70 (95% CI 0.69 to 0.72) (very low-certainty evidence). We did not pool data within the broader CDR categories or investigate heterogeneity due to the small quantity of data and the clinical heterogeneity of studies. Two studies were at high risk of bias. We identified two studies that are awaiting classification pending further information and two ongoing studies. AUTHORS' CONCLUSIONS There is insufficient evidence to determine the diagnostic test accuracy of CDRs to detect CSIs in children following blunt trauma, particularly for children under eight years of age. Although most studies had a high sensitivity, this was often achieved at the expense of low specificity and should be interpreted with caution due to a small number of CSIs and wide CIs. Well-designed, large studies are required to evaluate the accuracy of CDRs for the cervical spine clearance in children following blunt trauma, ideally in direct comparison with each other.
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Affiliation(s)
- Emma Tavender
- Emergency Research, Murdoch Children's Research Institute, Melbourne, Australia
- Departments of Paediatrics and Critical Care, University of Melbourne, Melbourne, Australia
| | - Nitaa Eapen
- Emergency Research, Murdoch Children's Research Institute, Melbourne, Australia
| | - Junfeng Wang
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Vanessa C Rausa
- Emergency Research, Murdoch Children's Research Institute, Melbourne, Australia
| | - Franz E Babl
- Emergency Research, Murdoch Children's Research Institute, Melbourne, Australia
- Departments of Paediatrics and Critical Care, University of Melbourne, Melbourne, Australia
- Emergency Department, The Royal Children's Hospital, Melbourne, Australia
| | - Natalie Phillips
- Emergency Department, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Australia
- Child Health Research Centre, University of Queensland, Brisbane, Australia
- Biomechanics and Spine Research Group, Centre for Children's Health Research, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Australia
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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] [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] [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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Siu WHS, Wang CJ, Wu CT, Wu CY, Ou LS. C1-C2 subluxation in enthesitis-related arthritis: two case reports and literature review of ten cases. Pediatr Rheumatol Online J 2023; 21:77. [PMID: 37537687 PMCID: PMC10401742 DOI: 10.1186/s12969-023-00862-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/24/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND C1-C2 subluxation is a rare complication of enthesitis-related arthritis (ERA). If left untreated, it may lead to functional impairment or cervical spinal cord compression. This study aims to highlight key points regarding the management of C1-C2 subluxation in ERA. CASE PRESENTATION We present two cases of C1-C2 subluxation: an 8-year-old boy with ERA and 16-year-old boy with ERA with bilateral sacroiliitis. Ten cases of ERA in the literature were reviewed. The diagnosis of C1-C2 subluxation is mostly based on radiographs and cervical spine computed tomography. All patients were treated with non-steroidal anti-inflammatory drugs. Six ERA patients were treated surgically for cervical fusion. Most ERA patients with sacroiliitis had cervical collar protection. Neurologic abnormalities after treatment were not reported. Despite the use of cervical collar, cervical fusion and persisting ankylosis were found in two ERA patients with sacroiliitis without surgical treatment. CONCLUSIONS Cervical spine protection and ruling out spinal cord compression should be prioritized, in addition to controlling the underlying inflammation in ERA. Cervical halter traction may be applied after severe cervical inflammation is excluded. To reduce the risk of complications, early recognition and appropriate treatments of C1-C2 subluxation in ERA are essential.
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Affiliation(s)
- Wing Hin Stanford Siu
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of Medical Education, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chao-Jan Wang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chieh-Tsai Wu
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chao-Yi Wu
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Kweishan, Taoyuan City, Taiwan
| | - Liang-Shiou Ou
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
- Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Kweishan, Taoyuan City, Taiwan.
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Zou Z, Kang S, Hou Y, Chen K. Pediatric spinal cord injury with radiographic abnormality: the Beijing experience. Spine J 2023; 23:403-411. [PMID: 36064092 DOI: 10.1016/j.spinee.2022.08.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spinal cord injury (SCI) without radiographic abnormality (SCIWORA) is a syndrome that usually occurs in children primarily because of the unique biomechanics of the pediatric spine. We recently found that the histopathological and behavioral effects of SCI with radiographic abnormality (SCIWRA) and SCIWORA are very different from each other in animal models. Although numerous studies were conducted to understand the epidemiological and clinical characteristics of the overall pediatric SCI population and the pediatric SCIWORA population, the characteristics of the pediatric SCIWRA population and their differences from those of the SCIWORA population are poorly understood. PURPOSE To describe the epidemiology and clinical outcomes of pediatric patients with SCIWRA and their differences from those with SCIWORA. STUDY DESIGN/SETTING Retrospective study. PATIENT SAMPLE A total of 47 pediatric SCIWRA patients. OUTCOME MEASURES Epidemiological characteristics, injury severities, functional deficits, and management and recovery outcomes. METHODS Review of all cases with SCIWRA at Beijing Children's Hospital between July 2007 and December 2019 and comparison between the present data and our previous SCIWORA data. RESULTS Of the 187 pediatric SCI patients, 47 had SCIWRA (age: 7.06 ± 3.75 years, male-to-female ratio: 3:2). Main causes of SCIWRA were fall (38%) and traffic accidents (38%). Lesions were often located at multiple levels (62%). Incubation period was 3 ± 18 hours. According to the American Spinal Injury Association impairment scale (AIS), many SCIWRA patients had incomplete impairment (AIS B, 9%; AIS C, 9%; AIS D, 32%). Specifically, many of them had abnormal upper and lower limb muscle powers (55% and 60%), upper and lower limb muscle tones (34% and 49%), sensation (38%), and knee, ankle, and abdominal reflexes (47%, 34%, and 36%). 72% of SCIWRA patients were treated with methylprednisolone, dexamethasone, or both. 81% of them showed neurological improvement before discharge. There was no association between corticosteroid therapy and neurological improvement. Moreover, functional outcomes of their upper and lower limb muscle powers were significantly associated with functional outcomes of their upper and lower limb muscle tones (p < 0.01), respectively. In comparison to the SCIWRA population, the SCIWORA population had a higher ratio of younger and female patients of sports-related thoracic injuries with long incubation period leading to lower-body deficits and complete impairment (p<0.05 or p<0.01). Despite all the differences, their neurological improvement was similar (p>0.05). CONCLUSIONS Demographic differences exist in the SCIWRA population. Corticosteroids do not appear to be effective in the different types of pediatric SCI. Limb muscle tone may be used to evaluate the functional status of limb muscle power. The epidemiological and clinical characteristics of SCIWRA and SCIWORA are very different from each other. It is important to formulate tailor-made prevention, evaluation, and management strategies for the pediatric population to optimize the SCI outcomes.
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Affiliation(s)
- Zhewei Zou
- Department of Neurology, Beijing Children's Hospital, 56 Nanlishi Road, Xicheng, Beijing, 100045, China
| | - Shaoyang Kang
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Yifu Science Hall, 37 Xueyuan Road, Haidian, Beijing, 100191, China
| | - Yuxin Hou
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Yifu Science Hall, 37 Xueyuan Road, Haidian, Beijing, 100191, China
| | - Kinon Chen
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Yifu Science Hall, 37 Xueyuan Road, Haidian, Beijing, 100191, China.
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Tian Y, Liu GE, Zhao WJ, Li L. Spinal cord injury in children caused by back-bend in dance. Chin J Traumatol 2023; 26:1. [PMID: 36041916 PMCID: PMC9912176 DOI: 10.1016/j.cjtee.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
| | | | | | - Lei Li
- Department of Trauma Surgery, War Trauma Medical Center, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, China.
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Clinical characteristics and treatment of spinal cord injury in children and adolescents. Chin J Traumatol 2023; 26:8-13. [PMID: 35478089 PMCID: PMC9912187 DOI: 10.1016/j.cjtee.2022.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/24/2022] [Accepted: 03/29/2022] [Indexed: 02/04/2023] Open
Abstract
Pediatric and adult spinal cord injuries (SCI) are distinct entities. Children and adolescents with SCI must suffer from lifelong disabilities, which is a heavy burden on patients, their families and the society. There are differences in Chinese and foreign literature reports on the incidence, injury mechanism and prognosis of SCI in children and adolescents. In addition to traumatic injuries such as car accidents and falls, the proportion of sports injuries is increasing. The most common sports injury is the backbend during dance practice. Compared with adults, children and adolescents are considered to have a greater potential for neurological improvement. The pathogenesis and treatment of pediatric SCI remains unclear. The mainstream view is that the mechanism of nerve damage in pediatric SCI include flexion, hyperextension, longitudinal distraction and ischemia. We also discuss the advantages and disadvantages of drugs such as methylprednisolone in the treatment of pediatric SCI and the indications and timing of surgery. In addition, the complications of pediatric SCI are also worthy of attention. New imaging techniques such as diffusion tensor imaging and diffusion tensor tractography may be used for diagnosis and assessment of prognosis. This article reviews the epidemiology, pathogenesis, imaging, clinical characteristics, treatment and complications of SCI in children and adolescents. Although current treatment cannot completely restore neurological function, patient quality of life can be enhanced. Continued developments and advances in the research of SCI may eventually provide a cure for children and adolescents with this kind of injury.
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Freigang V, Butz K, Seebauer CT, Karnosky J, Lang S, Alt V, Baumann F. Management and Mid-Term Outcome After "Real SCIWORA" in Children and Adolescents. Global Spine J 2022; 12:1208-1213. [PMID: 33406912 PMCID: PMC9210218 DOI: 10.1177/2192568220979131] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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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Zou Z, Teng A, Huang L, Luo X, Wu X, Zhang H, Chen K. Pediatric Spinal Cord Injury without Radiographic Abnormality: The Beijing Experience. Spine (Phila Pa 1976) 2021; 46:E1083-E1088. [PMID: 33710113 DOI: 10.1097/brs.0000000000004030] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To describe the epidemiology and clinical outcomes of pediatric patients with spinal cord injury (SCI) without radiographic abnormality (SCIWORA) in mainland China for the first time. SUMMARY OF BACKGROUND DATA SCIWORA is a syndrome that often occurs in children mainly due to the unique biomechanics of the pediatric spine. Although there have been numerous retrospective studies on pediatric SCIWORA, and mainland China has more patients with SCI than anywhere else, pediatric patients with SCIWORA in mainland China has not been described in any study. METHODS Review of all cases with SCIWORA at Beijing Children's Hospital between July 2007 and December 2019. RESULTS Of the 189 pediatric patients with SCI 140 had SCIWORA (age: 5.65 ± 2.60 years, male-to-female ratio: 2:5). Main causes of injuries were sports (41%, mostly backbend), falls (27%), traffic accidents (10%), and violence (8%). Lesions were located at the thoracic (77%), cervical (10%), multiple (5%), and lumbar (4%) levels. Incubation period was 2 ± 6 hours. Pathological characteristics of SCI were detected in 96% patients by magnetic resonance imaging (MRI). Based on the American Spinal Injury Association impairment scale (AIS), many patients had complete impairment (50% AIS A, 45% AIS B/C/D, 1% AIS E). Particularly, the five patients with normal MRI tended to have mild injury (AIS D) (P < 0.001), but they still showed abnormal reflex. In the one patient who could not be graded at all by AIS, his only functional deficits were abnormal upper and lower limb muscle tones. A total of 59% patients were treated with methylprednisolone, dexamethasone, or both. Out of 76 patients 59 showed neurological improvement before discharge. The only association among age, cause of injury, level of lesion, incubation period, AIS grade, type of corticosteroid therapy, and neurological improvement was between level of lesion and AIS grade (P < 0.001). CONCLUSION Demographic and clinical differences exist in patients with SCIWORA. MRI and detailed neurological examinations should both be performed for proper diagnosis. There is still a need to develop better treatment strategy for these patients.Level of Evidence: 4.
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Affiliation(s)
- Zhewei Zou
- Department of Neurology, Beijing Children's Hospital - 56 Nanlishi Road, Xicheng, Beijing, 100045, China
| | - Anna Teng
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University - Yifu Science Hall, 37 Xueyuan Road, Haidian, Beijing, 100191, China
| | - Liuyi Huang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University - Yifu Science Hall, 37 Xueyuan Road, Haidian, Beijing, 100191, China
| | - Xiuyuan Luo
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University - Yifu Science Hall, 37 Xueyuan Road, Haidian, Beijing, 100191, China
| | - Xinhao Wu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University - Yifu Science Hall, 37 Xueyuan Road, Haidian, Beijing, 100191, China
| | - Haocheng Zhang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University - Yifu Science Hall, 37 Xueyuan Road, Haidian, Beijing, 100191, China
| | - Kinon Chen
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University - Yifu Science Hall, 37 Xueyuan Road, Haidian, Beijing, 100191, China
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Alas H, Pierce KE, Brown A, Bortz C, Naessig S, Ahmad W, Moses MJ, O'Connell B, Maglaras C, Diebo BG, Paulino CB, Buckland AJ, Passias PG. Sports-related Cervical Spine Fracture and Spinal Cord Injury: A Review of Nationwide Pediatric Trends. Spine (Phila Pa 1976) 2021; 46:22-28. [PMID: 32991512 DOI: 10.1097/brs.0000000000003718] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Assess trends in sports-related cervical spine trauma using a pediatric inpatient database. SUMMARY OF BACKGROUND DATA Injuries sustained from sports participation may include cervical spine trauma such as fractures and spinal cord injury (SCI). Large database studies analyzing sports-related cervical trauma in the pediatric population are currently lacking. METHODS The Kid Inpatient Database was queried for patients with external causes of injury secondary to sports-related activities from 2003 to 2012. Patients were further grouped for cervical spine injury (CSI) type, including C1-4 and C5-7 fracture with/without spinal cord injury (SCI), dislocation, and SCI without radiographic abnormality (SCIWORA). Patients were grouped by age into children (4-9), pre-adolescents (Pre, 10-13), and adolescents (14-17). Kruskall-Wallis tests with post-hoc Mann-Whitney U's identified differences in CSI type across age groups and sport type. Logistic regression found predictors of TBI and specific cervical injuries. RESULTS A total of 38,539 patients were identified (12.76 years, 24.5% F). Adolescents had the highest rate of sports injuries per year (P < 0.001). Adolescents had the highest rate of any type of CSI, including C1-4 and C5-7 fracture with and without SCI, dislocation, and SCIWORA (all P < 0.001). Adolescence increased odds for C1-4 fracture w/o SCI 3.18×, C1-4 fx w/ SCI by 7.57×, C5-7 fx w/o SCI 4.11×, C5-7 w/SCI 3.63×, cervical dislocation 1.7×, and cervical SCIWORA 2.75×, all P < 0.05. Football injuries rose from 5.83% in 2009 to 9.14% in 2012 (P < 0.001), and were associated with more SCIWORA (1.6% vs. 1.0%, P = 0.012), and football injuries increased odds of SCI by 1.56×. Concurrent TBI was highest in adolescents at 58.4% (pre: 26.6%, child: 4.9%, P < 0.001), and SCIWORA was a significant predictor for concurrent TBI across all sports (odds ratio: 2.35 [1.77-3.11], P < 0.001). CONCLUSION Adolescent athletes had the highest rates of upper/lower cervical fracture, dislocation, and SCIWORA. Adolescence and SCIWORA were significant predictors of concurrent TBI across sports. The increased prevalence of CSI with age sheds light on the growing concern for youth sports played at a competitive level, and supports recently updated regulations aimed at decreasing youth athletic injuries. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Haddy Alas
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY
| | - Katherine E Pierce
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY
| | - Avery Brown
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY
| | - Cole Bortz
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY
| | - Sara Naessig
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY
| | - Waleed Ahmad
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY
| | - Michael J Moses
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY
| | - Brooke O'Connell
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY
| | - Constance Maglaras
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY
| | - Bassel G Diebo
- Department of Orthopedic Surgery, SUNY Downstate, New York, NY
| | - Carl B Paulino
- Department of Orthopedic Surgery, SUNY Downstate, New York, NY
| | - Aaron J Buckland
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY
| | - Peter G Passias
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY
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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] [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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Benmelouka A, Shamseldin LS, Nourelden AZ, Negida A. A Review on the Etiology and Management of Pediatric Traumatic Spinal Cord Injuries. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2019; 4:e28. [PMID: 32322796 PMCID: PMC7163256 DOI: 10.22114/ajem.v0i0.256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
CONTEXT Pediatric traumatic spinal cord injury (SCI) is an uncommon presentation in the emergency department. Severe injuries are associated with devastating outcomes and complications, resulting in high costs to both the society and the economic system. EVIDENCE ACQUISITION The data on pediatric traumatic spinal cord injuries has been narratively reviewed. RESULTS Pediatric SCI is a life-threatening emergency leading to serious outcomes and high mortality in children if not managed promptly. Pediatric SCI can impose many challenges to neurosurgeons and caregivers because of the lack of large studies with high evidence level and specific guidelines in terms of diagnosis, initial management and of in-hospital treatment options. Several novel potential treatment options for SCI have been developed and are currently under investigation. However, research studies into this field have been limited by the ethical and methodological challenges. CONCLUSION Future research is needed to investigate the safety and efficacy of the recent uprising neurodegenerative techniques in SCI population. Owing to the current limitations, there is a need to develop novel trial methodologies that can overcome the current methodological and ethical limitations.
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Affiliation(s)
| | | | | | - Ahmed Negida
- Medical Research Group of Egypt, Egypt
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
- Neurosurgery Department, Bahçeşehir University, Istanbul, Turkey
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15
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McAllister AS, Nagaraj U, Radhakrishnan R. Emergent Imaging of Pediatric Cervical Spine Trauma. Radiographics 2019; 39:1126-1142. [DOI: 10.1148/rg.2019180100] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Aaron S. McAllister
- From the Department of Radiology, Nationwide Children’s Hospital, 700 Children’s Dr, Columbus, OH 43205, and Department of Radiology, The Ohio State University, Columbus, Ohio (A.S.M.); Department of Radiology and Medical Imaging, Cincinnati Children’s Hospital, Cincinnati, Ohio (U.N.); and Department of Radiology and Imaging Sciences, Riley Hospital for Children at Indiana University Health, Indianapolis, Ind (R.R.)
| | - Usha Nagaraj
- From the Department of Radiology, Nationwide Children’s Hospital, 700 Children’s Dr, Columbus, OH 43205, and Department of Radiology, The Ohio State University, Columbus, Ohio (A.S.M.); Department of Radiology and Medical Imaging, Cincinnati Children’s Hospital, Cincinnati, Ohio (U.N.); and Department of Radiology and Imaging Sciences, Riley Hospital for Children at Indiana University Health, Indianapolis, Ind (R.R.)
| | - Rupa Radhakrishnan
- From the Department of Radiology, Nationwide Children’s Hospital, 700 Children’s Dr, Columbus, OH 43205, and Department of Radiology, The Ohio State University, Columbus, Ohio (A.S.M.); Department of Radiology and Medical Imaging, Cincinnati Children’s Hospital, Cincinnati, Ohio (U.N.); and Department of Radiology and Imaging Sciences, Riley Hospital for Children at Indiana University Health, Indianapolis, Ind (R.R.)
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Abstract
OBJECTIVE The aim of this study was to ascertain potential factors associated with cervical spine injuries in children injured during sports and recreational activities. METHODS This is a secondary analysis of a multicenter retrospective case-control study involving children younger than 16 years who presented to emergency departments after blunt trauma and underwent cervical spine radiography. Cases had cervical spine injury from sports or recreational activities (n = 179). Comparison groups sustained (1) cervical spine injury from other mechanisms (n = 361) or (2) other injuries from sports and recreational activities but were free of cervical spine injury (n = 180). RESULTS For children with sport and recreational activity-related cervical spine injuries, common injury patterns were subaxial (49%) and fractures (56%). These children were at increased odds of spinal cord injury without radiographic abnormalities compared with children with cervical spine injuries from other mechanisms (25% vs 6%). Children with sport and recreational activity-related trauma had increased odds of cervical spine injury if they had focal neurologic findings (odds ratio [OR], 5.7; 95% confidence interval [CI], 3.5-9.4), had complaints of neck pain (OR, 3.1; 95% CI, 1.9-5.0), were injured diving (OR, 43.5; 95% CI, 5.9-321.3), or sustained axial loading impacts (OR, 2.2; 95% CI, 1.3-3.5). Football (22%), diving (20%), and bicycle crashes (11%) were the leading activities associated with cervical spine injury. CONCLUSIONS In children injured during sports and recreational activities, focal neurologic findings, neck pain, axial loading impacts, and the possibility of spinal cord injury without radiographic abnormality should guide the diagnostic evaluation for potential cervical spine injuries. Certain activities have a considerable frequency of cervical spine injury, which may benefit from activity-specific preventive measures.
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Abstract
“Spinal Cord Injury without Radiographic Abnormality” (SCIWORA) is a term that denotes objective clinical signs of posttraumatic spinal cord injury without evidence of fracture or malalignment on plain radiographs and computed tomography (CT) of the spine. SCIWORA is most commonly seen in children with a predilection for the cervical spinal cord due to the increased mobility of the cervical spine, the inherent ligamentous laxity, and the large head-to-body ratio during childhood. However, SCIWORA can also be seen in adults and, in rare cases, the thoracolumbar spinal cord can be affected too. Magnetic resonance imaging (MRI) has become a valuable diagnostic tool in patients with SCIWORA because of its superior ability to identify soft tissue lesions such as cord edema, hematomas and transections, and discoligamentous injuries that may not be visualized in plain radiographs and CT. The mainstay of treatment in patients with SCIWORA is nonoperative management including steroid therapy, immobilization, and avoidance of activities that may increase the risk of exacerbation or recurrent injury. Although the role of operative treatment in SCIWORA can be controversial, surgical alternatives such as decompression and fusion should be considered in selected patients with clinical and MRI evidence of persistent spinal cord compression and instability.
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18
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Cassar-Pullicino VN, Leone A. Imaging in paediatric spinal injury. TRAUMA-ENGLAND 2017. [DOI: 10.1177/1460408617725781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Paediatric spinal injury is rare and exhibits many unique features. Attending clinicians and radiologists often lack knowledge, expertise and experience in dealing with a potential injury to the paediatric spine. Within the paediatric age range itself there are different age-dependent mechanisms that can injure the paediatric spine. Moreover, the anatomical features and degree of osseous maturity of the developing paediatric spine determine the biomechanical characteristics which promote unique patterns of spinal injury in each paediatric age group. Methods An expert illustrated narrative review of the literature. Results Multiple factors make the imaging interpretation of the injured paediatric spine challenging. Each imaging modality has strengths and weaknesses in depicting spinal anatomy which vary with the type of spinal injury and age of the paediatric patient. Conclusions Attending doctors need to be familiar with the imaging appearances of the normal paediatric spine, its normal variants as well as the imaging features characteristics of paediatric spinal injury seen on radiographs, computed tomography and magnetic resonance imaging.
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Affiliation(s)
| | - Antonio Leone
- Institute of Radiology, School of Medicine, Catholic University, Rome, Italy
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Nagasawa H, Ishikawa K, Takahashi R, Takeuchi I, Jitsuiki K, Ohsaka H, Omori K, Yanagawa Y. A case of real spinal cord injury without radiologic abnormality in a pediatric patient with spinal cord concussion. Spinal Cord Ser Cases 2017; 3:17051. [PMID: 28839952 DOI: 10.1038/scsandc.2017.51] [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: 04/05/2017] [Revised: 07/06/2017] [Accepted: 07/10/2017] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Real spinal cord injury without radiologic abnormality (SCIWORA) is a rare clinical entity. CASE PRESENTATION The patient was a 13-year-old girl whose body was overturned anteriorly after crashing her bicycle into a curb. Following the accident, in which her neck and upper back hit the ground, she could not move due to paralysis. On arrival, she had paresis of the bilateral upper extremities and experienced a painful sensation when her upper extremities were touched. Cervical roentgenography and whole-body computed tomography revealed no traumatic lesions in either the intracranium or the cervical bone. Urgent spinal magnetic resonance imaging (MRI) showed no significant spinal cord lesions or spinal canal stenosis. She was put on complete bed rest with a cervical collar. On the 2nd hospital day (24 h after the accident), her motor weakness had almost completely subsided, and she felt only mild dysesthesia in both forearms. Roentgenography revealed no instability. Her motor weakness completely recovered on the third day after accident and she was diagnosed with spinal cord concussion. DISCUSSION The present case study, in which MRI was performed, showed that an immediate improvement was obtained in a patient who experienced real SCIWORA. The importance of not only spinal cord lesions, but also perispinal soft tissue injury on MRI has been emphasized for predicting patient outcomes. Accordingly, immediate MRI is essential for evaluating patients with signs and symptoms of spinal cord injury, even when plain neck roentgenography and cervical CT are negative.
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Affiliation(s)
- Hiroki Nagasawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Kouhei Ishikawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Ryosuke Takahashi
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Ikuto Takeuchi
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Kei Jitsuiki
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Kazuhiko Omori
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
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Dhillon JK, Shi J, Janezic A, Wheeler KK, Xiang H, Leonard JC. U.S. Estimates of Pediatric Spinal Cord Injury: Implications for Clinical Care and Research Planning. J Neurotrauma 2017; 34:2019-2026. [PMID: 28034346 DOI: 10.1089/neu.2016.4774] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to provide accurate estimates and characterizations of children with spinal cord injuries (SCIs) and for the subset that are appropriate for inclusion in clinical trials. We identified children <18 years of age with SCI International Classifications of Diseases, Ninth Revision, Clinical Modification Codes (ICD-9-CM codes) from the 2006, 2009, and 2012 Kids' Inpatient Database. We excluded those with late effects, transfers to other hospitals, unspecified injury levels, and hospital stays <48 h. We then used conventional rationale to identify children who were eligible for SCI clinical trials. Over 3 years, 2484 children had SCI ICD-9-CM codes; 1342 had coding consistent with true SCI and 706 satisfied clinical trial inclusion criteria, yielding national estimates of 2013 and 1062, respectively. Of children with clinical trial eligible SCI, injuries were more common in the cervical region (66.1%), males (65.5%), older children (51.1% were 16-17 years old), and the South (49.8%). The majority were treated at urban teaching hospitals (84.6%); however, only 20.3% were treated at pediatric-specific centers. Of the 445 sample hospitals treating children with SCI, 66.3% treated just 1 child in the 3-year period. Children eligible for SCI clinical trials represented less than one third of children with SCI ICD-9-CM codes. These children were regionally localized to the South, with few receiving treatment at pediatric-specific centers or centers that frequently care for children with SCI. These findings highlight the importance of carefully assessing the national distribution of children with SCI, so that resources are appropriately allocated to optimize clinical care and research outcomes.
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Affiliation(s)
| | - Junxin Shi
- 2 The Center for Injury Research and Policy and The Center for Pediatric Trauma Research , Nationwide Children's Hospital, Columbus, Ohio
| | - Alyssa Janezic
- 2 The Center for Injury Research and Policy and The Center for Pediatric Trauma Research , Nationwide Children's Hospital, Columbus, Ohio
| | - Krista K Wheeler
- 2 The Center for Injury Research and Policy and The Center for Pediatric Trauma Research , Nationwide Children's Hospital, Columbus, Ohio
| | - Henry Xiang
- 1 The Ohio State University College of Medicine , Columbus, Ohio.,2 The Center for Injury Research and Policy and The Center for Pediatric Trauma Research , Nationwide Children's Hospital, Columbus, Ohio
| | - Julie C Leonard
- 1 The Ohio State University College of Medicine , Columbus, Ohio.,2 The Center for Injury Research and Policy and The Center for Pediatric Trauma Research , Nationwide Children's Hospital, Columbus, Ohio
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Abstract
PURPOSE OF REVIEW The current review describes the current evidence on pediatric spinal cord injury without radiographic abnormality (SCIWORA) with attention to the definition, epidemiology, and clinical presentation of the condition, as well as common MRI findings, management strategies, and outcomes. RECENT FINDINGS Recent literature demonstrates that with more widespread MRI use, our understanding of SCIWORA has improved. The new literature, although still limited, provides a more granular conceptualization of patterns of injury as well as potential prognostic stratification of patients based on MRI findings. Through case studies and national database analyses, researchers have further defined the epidemiology and outcomes of SCIWORA. SUMMARY Although SCIWORA occurs infrequently, thus making robust research a challenge, maintaining a high suspicion in the appropriate clinical setting ought to prompt acquisition of advanced imaging. For patients with persisting neurologic symptoms after trauma, despite negative plain films and cervical spine computed tomography, MRI can be helpful diagnostically as well as prognostically. Once SCIWORA is diagnosed, patients are treated nonoperatively with hard collar immobilization and physical therapy.
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Shah K, Tikoo A, Kothari MK, Nene A. Current Concepts in Pediatric Cervical Spine Trauma. Open Orthop J 2017; 11:346-352. [PMID: 28603566 PMCID: PMC5447926 DOI: 10.2174/1874325001711010346] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 07/10/2016] [Accepted: 07/15/2016] [Indexed: 12/23/2022] Open
Abstract
Background: Pediatric spinal trauma is rare and challenging entity. Although cervical spine is commonly affected, it is often missed on routine imaging investigations. Therefore better understanding of growing spine and its patho-physiology is crucial. Methods: Articles related to pediatric cervical trauma were searched on Pubmed and other online research data banks. We have summarized unique anatomy of pediatric spine, investigations followed by common injury patterns, their diagnostic challenges and management. Results: Immature spine follows typical injury patterns, so thorough knowledge of its presentation should be known. Primary physicians should be able to perform initial assessment based on clinical examination and investigations for early diagnosis. High index of suspicion and strategic approach leads to early diagnosis and prevents further morbidity and mortality. Conclusion: Spinal injuries in children are rare and typical. They are often missed and can have fatal consequences. Thorough understanding of pediatric anatomy and injury patterns helps in early diagnosis.
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Affiliation(s)
- Kunal Shah
- Wockhardt Hospitals, 1877, Dr. Anand Rao Nair Road, Mumbai Central (E), Mumbai- 400 011, India
| | - Agnivesh Tikoo
- Wockhardt Hospitals, 1877, Dr. Anand Rao Nair Road, Mumbai Central (E), Mumbai- 400 011, India
| | - Manish K Kothari
- Wockhardt Hospitals, 1877, Dr. Anand Rao Nair Road, Mumbai Central (E), Mumbai- 400 011, India
| | - Abhay Nene
- Wockhardt Hospitals, 1877, Dr. Anand Rao Nair Road, Mumbai Central (E), Mumbai- 400 011, India
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Moore JM, Hall J, Ditchfield M, Xenos C, Danks A. Utility of plain radiographs and MRI in cervical spine clearance in symptomatic non-obtunded pediatric patients without high-impact trauma. Childs Nerv Syst 2017; 33:249-258. [PMID: 27924366 DOI: 10.1007/s00381-016-3273-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 10/07/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE The optimal imaging modality for evaluating cervical spine trauma and optimizing management in the pediatric population is controversial. In pediatric populations, there are no well-established guidelines for cervical spine trauma evaluation and treatment. Currently, there is virtually no literature regarding imaging and management of symptomatic pediatric patients who present with cervical spine trauma without high-impact mechanism. This study aims to establish an optimal imaging strategy for this subgroup of trauma patients. METHODS We performed a retrospective review of pediatric patients (aged below 18 years) who were admitted to Monash Medical Centre, Melbourne, Australia between July 2011 and June 2015, who did not suffer a high-impact trauma but were symptomatic for cervical spine injury following cervical trauma. Imaging and management strategies were reviewed and results compared. RESULTS Forty-seven pediatric patients were identified who met the inclusion criteria. Of these patients, 46 underwent cervical spine series (CSS) plain radiograph imaging. Thirty-four cases underwent magnetic resonance imaging (MRI) and 9 patients underwent CT. MRI was able to detect 4 cases of ligamentous injury, which were not seen in CSS imaging and was able to facilitate cervical spine clearance in a further two patients whose CSS radiographs were abnormal. CONCLUSION In this study, MRI has a greater sensitivity and specificity when compared to CSS radiography in a symptomatic pediatric low-impact trauma population. Our data call in to question the routine use of CSS radiographs in children.
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Affiliation(s)
- Justin M Moore
- Department of Neurosurgery, Monash Medical Centre, 246 Clayton Rd, Melbourne, Clayton, VIC 3168, Australia.
| | - Jonathan Hall
- Department of Neurosurgery, Monash Medical Centre, 246 Clayton Rd, Melbourne, Clayton, VIC 3168, Australia
| | - Michael Ditchfield
- Department of Pediatric Imaging, Monash Medical Centre, Melbourne, Australia
| | - Christopher Xenos
- Department of Neurosurgery, Monash Medical Centre, 246 Clayton Rd, Melbourne, Clayton, VIC 3168, Australia
| | - Andrew Danks
- Department of Neurosurgery, Monash Medical Centre, 246 Clayton Rd, Melbourne, Clayton, VIC 3168, Australia
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Madura CJ, Johnston JM. Classification and Management of Pediatric Subaxial Cervical Spine Injuries. Neurosurg Clin N Am 2016; 28:91-102. [PMID: 27886885 DOI: 10.1016/j.nec.2016.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Appropriate management of subaxial spine injury in children requires an appreciation for the differences in anatomy, biomechanics, injury patterns, and treatment options compared with adult patients. Increased flexibility, weak neck muscles, and cranial disproportion predispose younger children to upper cervical injuries and spinal cord injury without radiographic abnormality. A majority of subaxial cervical spine injuries can be treated nonoperatively. Surgical instrumentation options for children have significantly increased in recent years. Future studies of outcomes for children with subaxial cervical spine injury should focus on injury classification and standardized outcome measures to ensure continued improvement in quality of care for this patient population.
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Affiliation(s)
- Casey J Madura
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Children's of Alabama, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder Suite 400, Birmingham, Alabama 35233, USA
| | - James M Johnston
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Children's of Alabama, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder Suite 400, Birmingham, Alabama 35233, USA.
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Baumann F, Ernstberger T, Neumann C, Nerlich M, Schroeder GD, Vaccaro AR, Loibl M. Pediatric Cervical Spine Injuries: A Rare But Challenging Entity. ACTA ACUST UNITED AC 2016; 28:E377-84. [PMID: 26165728 DOI: 10.1097/bsd.0000000000000307] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Injuries to the cervical spine in pediatric patients are uncommon. A missed injury can have devastating consequences in this age group. Because of the lack of routine in diagnosis and management of pediatric cervical spine injuries (PCSI), each of these cases represents a logistic and personal challenge. METHODS By means of clinical cases, we demonstrate key points in diagnostics and treatment of pediatric spine injuries. We highlight typical pediatric injury patterns and more adult-like injuries. RESULTS The most common cause of injury is blunt trauma. There is an age-related pattern of injuries in pediatric patients. Children under the age of 8 frequently sustain ligamentous injuries in the upper cervical spine. After the age of 8, the biomechanics of the cervical spine are similar to adults, and therefore, bony injuries of the subaxial cervical spine are most likely to occur. Clinical presentation of PCSI is heterogeneous. Younger children can neither interpret nor communicate neurological abnormalities, which make timely and accurate diagnosis difficult. Plain radiographs are often misinterpreted. We find different types of injuries at different locations, because of different biomechanical properties of the immature spine. We outline that initial management is crucial for long-term outcome. CONCLUSIONS Knowledge of biomechanical properties and radiographic presentation of the immature spine can improve the awareness for PCSI. Diagnosis and management of pediatric patients after neck trauma can be demanding. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Florian Baumann
- *Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany †The Rothman Institute at Thomas Jefferson University, Philadelphia, PA
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Spinal cord injury without radiographic abnormality (SCIWORA) in adults: MRI type predicts early neurologic outcome. Spinal Cord 2016; 54:878-883. [PMID: 26882492 DOI: 10.1038/sc.2016.13] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/15/2015] [Accepted: 12/18/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The present study aimed to analyse the clinical and neuroimaging features of a consecutive series of adult patients with spinal cord injury without radiographic abnormality (SCIWORA) receiving early magnetic resonance imaging (MRI), and to apply the recently proposed MRI classification system. METHODS Grade of neurologic impairment at admission and discharge was reported according to the American Spinal Injury Association Impairment Scale (AIS). A detailed analysis and categorisation of the extra- and intramedullary MRI findings was performed, and the relationship between imaging type and neurological outcome was described. RESULTS Twenty-six adult patients (17 male and 9 female) with SCIWORA were identified (mean age of 52 years). The distribution of the initial AIS grade was 8% A (n=2), 19% B (n=5), 31% C (n=8) and 42% D (n=11) at admission and 15% (n=4) C, 58% (n=15) D and 27% (n=7) E at discharge, respectively. Type I SCIWORA was found in 23% (n=6) and type II in 77% (n=20) (IIa: 0%, IIb: 25%, IIc: 75%). The mean improvement of AIS grade in patients with type I lesions was 1.5 (median 1, range 1-3) and 0.9 (median 1, range 0-3) in type II. CONCLUSION The findings underline the prognostic role of early MRI for adult patients with SCIWORA and support the use of the recently introduced MRI classification system. LEVEL OF EVIDENCE Prognostic study, level III.
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Will the Real SCIWORA Please Stand Up? Exploring Clinicoradiologic Mismatch in Closed Spinal Cord Injuries. AJR Am J Roentgenol 2015; 205:853-60. [PMID: 26397336 DOI: 10.2214/ajr.14.13374] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This article aims to familiarize radiologists with the terms used to describe clinicoradiologic mismatch in blunt spinal cord injuries, and also assesses MRI findings and their prognostic value for both pediatric and adult patients. CONCLUSION Knowledge of the lexicon of spinal cord injury without radiographic abnormality, the spectrum of MRI findings, and imaging predictors of outcome can help render a precise imaging diagnosis and can provide evidence-based prognostic information.
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Spinal cord injuries without radiologic abnormality in children: a systematic review. Spinal Cord 2015; 53:842-8. [DOI: 10.1038/sc.2015.110] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 05/18/2015] [Accepted: 05/29/2015] [Indexed: 11/08/2022]
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Early MRI finding in adult spinal cord injury without radiologic abnormalities does not correlate with the neurological outcome: a retrospective study. Spinal Cord 2015; 53:750-3. [DOI: 10.1038/sc.2015.45] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 02/04/2015] [Accepted: 02/09/2015] [Indexed: 11/08/2022]
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Huisman TAGM, Wagner MW, Bosemani T, Tekes A, Poretti A. Pediatric spinal trauma. J Neuroimaging 2014; 25:337-53. [PMID: 25512255 DOI: 10.1111/jon.12201] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/23/2014] [Accepted: 08/16/2014] [Indexed: 12/19/2022] Open
Abstract
Pediatric spinal trauma is unique. The developing pediatric spinal column and spinal cord deal with direct impact and indirect acceleration/deceleration or shear forces very different compared to adult patients. In addition children are exposed to different kind of traumas. Moreover, each age group has its unique patterns of injury. Familiarity with the normal developing spinal anatomy and kind of traumas is essential to correctly diagnose injury. Various imaging modalities can be used. Ultrasound is limited to the neonatal time period; plain radiography and computer tomography are typically used in the acute work-up and give highly detailed information about the osseous lesions. Magnetic resonance imaging is more sensitive for disco-ligamentous and spinal cord injuries. Depending on the clinical presentation and timing of trauma the various imaging modalities will be employed. In the current review article, a summary of the epidemiology and distribution of posttraumatic lesions is discussed in the context of the normal anatomical variations due to progressing development of the child.
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Affiliation(s)
- Thierry A G M Huisman
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Pediatric Radiology, Section of Pediatric Neuroradiology, The Johns Hopkins University School of Medicine, Baltimore, MD
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Lumba-Brown A, Pineda J. Evidence-based assessment of severe pediatric traumatic brain injury and emergent neurocritical care. Semin Pediatr Neurol 2014; 21:275-83. [PMID: 25727509 DOI: 10.1016/j.spen.2014.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Pediatric traumatic brain injury accounts for approximately 474,000 emergency department visits, 37,000 hospitalizations, and 3,000 deaths in children 14 years and younger annually in the United States. Acute neurocritical care in children has advanced with specialized pediatric trauma centers and emergency medical services. This article reviews pediatric-specific diagnosis, management, and medical decision making related to the neurocritical care of severe traumatic brain injury.
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Affiliation(s)
- Angela Lumba-Brown
- Division of Pediatric Emergency Medicine, Washington University School of Medicine, St. Louis, MO..
| | - Jose Pineda
- Pediatric Neurocritical Care, Washington University School of Medicine, St. Louis, MO
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Giovedì 2 Ottobre. Neuroradiol J 2014. [DOI: 10.1177/197140091402700505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Grahn PJ, Mallory GW, Berry BM, Hachmann JT, Lobel DA, Lujan JL. Restoration of motor function following spinal cord injury via optimal control of intraspinal microstimulation: toward a next generation closed-loop neural prosthesis. Front Neurosci 2014; 8:296. [PMID: 25278830 PMCID: PMC4166363 DOI: 10.3389/fnins.2014.00296] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 08/31/2014] [Indexed: 11/13/2022] Open
Abstract
Movement is planned and coordinated by the brain and carried out by contracting muscles acting on specific joints. Motor commands initiated in the brain travel through descending pathways in the spinal cord to effector motor neurons before reaching target muscles. Damage to these pathways by spinal cord injury (SCI) can result in paralysis below the injury level. However, the planning and coordination centers of the brain, as well as peripheral nerves and the muscles that they act upon, remain functional. Neuroprosthetic devices can restore motor function following SCI by direct electrical stimulation of the neuromuscular system. Unfortunately, conventional neuroprosthetic techniques are limited by a myriad of factors that include, but are not limited to, a lack of characterization of non-linear input/output system dynamics, mechanical coupling, limited number of degrees of freedom, high power consumption, large device size, and rapid onset of muscle fatigue. Wireless multi-channel closed-loop neuroprostheses that integrate command signals from the brain with sensor-based feedback from the environment and the system's state offer the possibility of increasing device performance, ultimately improving quality of life for people with SCI. In this manuscript, we review neuroprosthetic technology for improving functional restoration following SCI and describe brain-machine interfaces suitable for control of neuroprosthetic systems with multiple degrees of freedom. Additionally, we discuss novel stimulation paradigms that can improve synergy with higher planning centers and improve fatigue-resistant activation of paralyzed muscles. In the near future, integration of these technologies will provide SCI survivors with versatile closed-loop neuroprosthetic systems for restoring function to paralyzed muscles.
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Affiliation(s)
- Peter J. Grahn
- Mayo Clinic College of Medicine, Mayo ClinicRochester, MN, USA
| | | | | | - Jan T. Hachmann
- Department of Neurologic Surgery, Mayo ClinicRochester, MN, USA
| | | | - J. Luis Lujan
- Department of Neurologic Surgery, Mayo ClinicRochester, MN, USA
- Department of Physiology and Biomedical Engineering, Mayo ClinicRochester, MN, USA
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Spinal cord injury without radiologic abnormality in children imaged with magnetic resonance imaging. J Trauma Acute Care Surg 2014; 76:1334-5. [PMID: 24747474 DOI: 10.1097/ta.0000000000000172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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