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Pirillo V, Berti PP, Prontera A, Rizzo P, Broger M. Biomechanics considerations in the treatment of double traumatic non-contiguous subaxial cervical lesions. Br J Neurosurg 2023; 37:1781-1785. [PMID: 33792457 DOI: 10.1080/02688697.2021.1907309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
Double traumatic non-contiguous lesions of the subaxial cervical region are a rare event mostly caused by multiple, simultaneous or rapidly consecutive high-energy-impact traumas. The modality of treatment chosen for these lesions must be related to local lower cervical spine biomechanics. We present the case of a 59 year-old patient who suffered a subaxial cervical spine double fracture-dislocation following a complex-dynamic trauma. Radiological imaging displayed a C4-C5 and C7-T1 fracture-dislocation with cord signal intensity abnormalities. This patient showed a complete neurological deficit (ASIA A; mJOA 0) with a C4 sensory-motor level. He was urgently operated upon through an anterior approach, reduction of both dislocations and positioning of intervertebral cages and anterior plates at C4-C5 and C7-T1. At a 16-month follow-up he displays neurological improvement, moving his upper extremities at the C7-C8 motor level and a T5 sensory level (mJOA 3; Odom's Criteria 3). The check-CT scan at 24-month shows the correct positioning of the stabilization system and a complete bone fusion.Double traumatic lesions of the subaxial cervical spine, when interposed by healthy functional segments can be treated as two single independent lesions in order to allow a better outcome.
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Affiliation(s)
- Vania Pirillo
- Department of Neurosurgery, S. Maurizio Hospital, Bolzano, Italy
| | - Pier Paolo Berti
- Department of Neurosurgery, Civile Maggiore Hospital, University of Verona, Verona, Italy
| | - Andrea Prontera
- Department of Neurosurgery, S. Maurizio Hospital, Bolzano, Italy
| | - Paolo Rizzo
- Department of Neurosurgery, S. Maurizio Hospital, Bolzano, Italy
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Tabarestani TQ, Lewis NE, Kelly-Hedrick M, Zhang N, Cellini BR, Marrotte EJ, Williamson T, Wang H, Laskowitz DT, Faw TD, Abd-El-Barr MM. Surgical Considerations to Improve Recovery in Acute Spinal Cord Injury. Neurospine 2022; 19:689-702. [PMID: 36203295 PMCID: PMC9537855 DOI: 10.14245/ns.2244616.308] [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: 07/01/2022] [Accepted: 09/07/2022] [Indexed: 12/14/2022] Open
Abstract
Acute traumatic spinal cord injury (SCI) can be a devastating and costly event for individuals, their families, and the health system as a whole. Prognosis is heavily dependent on the physical extent of the injury and the severity of neurological dysfunction. If not treated urgently, individuals can suffer exacerbated secondary injury cascades that may increase tissue injury and limit recovery. Initial recognition and rapid treatment of acute SCI are vital to limiting secondary injury, reducing morbidity, and providing the best chance of functional recovery. This article aims to review the pathophysiology of SCI and the most up-to-date management of the acute traumatic SCI, specifically examining the modern approaches to surgical treatments along with the ethical limitations of research in this field.
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Affiliation(s)
| | - Nicholle E. Lewis
- Doctor of Physical Therapy Division, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | | | - Nina Zhang
- Department of Psychology and Neuroscience, Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Brianna R. Cellini
- Department of Psychology and Neuroscience, Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Eric J. Marrotte
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Theresa Williamson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA,Center for Bioethics, Harvard Medical School, Boston, MA, USA
| | - Haichen Wang
- Department of Neurology, Duke University, Durham, NC, USA
| | | | - Timothy D. Faw
- Doctor of Physical Therapy Division, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA,Duke Institute for Brain Sciences, Duke University, Durham, NC, USA
| | - Muhammad M. Abd-El-Barr
- Department of Neurosurgery, Duke University, Durham, NC, USA,Corresponding Author Muhammad M. Abd-El-Barr Department of Neurosurgery, Duke University Medical Center 2840, Room 5335 5th Floor, Orange Zone, Duke South, Durham, NC 27710, USA
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Abuamona R, Salem S, Tschan CA, Elsharkawy AE. Using 3D navigation in sitting position in dorsal stabilization for traumatic cervical fracture–dislocations in an emergency situation: A Case series and technical notes. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ren C, Qin R, Li Y, Wang P. Anterior reduction and fusion for acute unilateral cervical facet dislocation without severe spinal cord injuries. J Clin Neurosci 2020; 78:102-107. [PMID: 32624368 DOI: 10.1016/j.jocn.2020.05.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/20/2020] [Accepted: 05/27/2020] [Indexed: 12/09/2022]
Abstract
PURPOSE This study aimed to evaluate safety and effectiveness of simple anterior reduction and fusion for acute lower cervical unilateral facet dislocation without severe spinal cord injuries. MATERIALS AND METHODS One hundred and two patients with unilateral cervical facet dislocations without severe spinal cord injuries who were surgically treated by the only anterior approach were analyzed. The treatment effects were evaluated based on the Visual Analogue Scale (VAS) scores, the Cobb angle of kyphosis, the Neck Disability Index (NDI) and Odom's criteria. Neurological recovery of patients was assessed by the Frankel grading. RESULTS The mean duration of follow-up was 12.4 ± 4.2 years (range, 10 to 17 years). VAS scores, Kyphosis angle and NDI scores were significantly changed from preoperative values of 7.4 ± 0.8, 11.3° ± 6.8° and 29.3 ± 5.1 to last follow-up values of 1.3 ± 0.8, -6.1° ± 7.5° and 8.8 ± 3.6 (P = 0.000). Of patients, 92 (90.2%) had good to excellent outcomes, 9 (8.8%) had satisfactory outcomes, and 1 (1.0%) had poor outcomes. Patients have obtained satisfactory neurological recovery. Three patients needed additional posterior reduction. CONCLUSION The anterior reduction and fusion is effective and safe for acute unilateral cervical facet dislocation, and can achieve good long-term clinical effects.
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Affiliation(s)
- Chunpeng Ren
- Dept. Orthoped., Lianyungang No.1 People' s Hospital, Xuzhou Academy of Medical Sciences, 182 Tongguang Rd, Lianyungang, Jiangsu 222002, China
| | - Rujie Qin
- Dept. Orthoped., Lianyungang No.1 People' s Hospital, Xuzhou Academy of Medical Sciences, 182 Tongguang Rd, Lianyungang, Jiangsu 222002, China.
| | - Yin Li
- Dept. Orthoped., Lianyungang No.1 People' s Hospital, Xuzhou Academy of Medical Sciences, 182 Tongguang Rd, Lianyungang, Jiangsu 222002, China
| | - Peng Wang
- Dept. Orthoped., Lianyungang No.1 People' s Hospital, Xuzhou Academy of Medical Sciences, 182 Tongguang Rd, Lianyungang, Jiangsu 222002, China
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Comparison of anterior and posterior approaches for treatment of traumatic cervical dislocation combined with spinal cord injury: Minimum 10-year follow-up. Sci Rep 2020; 10:10346. [PMID: 32587305 PMCID: PMC7316727 DOI: 10.1038/s41598-020-67265-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 06/03/2020] [Indexed: 01/17/2023] Open
Abstract
Anterior reduction and interbody fusion fixation has not been compared directly with posterior reduction and short-segmental pedicle screw fixation for lower cervical dislocation, and so consensus is lacking as to which is the optimal method. The purpose of this paper is to compare long-term outcomes of the anterior versus posterior approach for traumatic cervical dislocation with spinal cord injury. One hundred and fifty-nine patients could be followed for more than 10 years (follow-up rate 84.1%). Ninety-two patients underwent anterior reduction and interbody fusion and fixation, and 67 patients underwent posterior reduction and short-segmental pedicle screw fixation. Japanese Orthopaedic Association (JOA) scores, the Neck Disability Index (NDI), the American Spinal Injury Association grading (ASIA), Odom's criteria, cervical kyphosis, operative parameters, and surgical or post-operative complications were evaluated. Patients were followed for 10 to 17 years. There was no significant difference in main JOA scores, NDI scores or ASIA scores between the two groups at follow-up. The posterior approach was associated with greater loss of alignment by two years (P = 0.012) and at final follow-up (P < 0.001). The posterior approach group had more blood loss (P < 0.001), longer operation times (P < 0.001), longer hospital stays (P < 0.001) and fewer complications than the anterior approach group. The anterior approach is better than the posterior approach for preserving cervical lordosis, which is associated with a better long-term effect.
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