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Yang Q, Yang ZC, Liu CX, Zeng H. Severe traumatic dislocation of the lower cervical spine with mild neurological symptoms: Case reports and literature review. J Spinal Cord Med 2024:1-7. [PMID: 38996215 DOI: 10.1080/10790268.2024.2374131] [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] [Indexed: 07/14/2024] Open
Abstract
CONTEXT Severe traumatic fractures and dislocations of the lower cervical spine are usually accompanied by irreversible spinal cord injuries. Such patients rarely have mild or no neurological symptoms. FINDINGS We report three cases of severe lower cervical dislocation without spinal cord injury and discuss the mechanisms underlying this type of injury. All three patients had severe lower cervical dislocation, but their neurological symptoms were mild. In all cases, the fractures occurred at the bilateral junctions of the lamina and pedicle, resulting in severe cervical spondylolisthesis, whereas the posterior structure remained in place, thereby increasing the cross-sectional area of the spinal canal. After preoperative skull traction for a few days, the patients underwent anterior or combined anterior and posterior cervical surgeries. All surgeries were successfully completed and the patient's symptoms disappeared at the last follow-up. CONCLUSION Severe traumatic dislocation of the lower cervical spine with an intact neurological status is rare in clinical practice. Pathological canal enlargement preserves neurological function, and the most commonly injured segment is C7. Preoperative traction for closed reduction remains controversial. We suggest that if no obvious anterior compression is observed, closed reduction should be pursued. Anterior or combined anterior and posterior cervical surgeries can provide rigid fixation with satisfactory results.
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Affiliation(s)
- Qian Yang
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Ze-Chuan Yang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Chao-Xu Liu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Heng Zeng
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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2
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Nkurikiyumukiza L, Buteera AM, El-Sharkawi MM. Delayed presentation of lower cervical facet dislocations: What to learn from past reports? SICOT J 2024; 10:4. [PMID: 38240730 PMCID: PMC10798230 DOI: 10.1051/sicotj/2023036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/08/2023] [Indexed: 01/22/2024] Open
Abstract
Delayed presentation of lower cervical facet dislocations is uncommon, and there is no standardized way to approach these neglected injuries. The literature on neglected lower cervical facet dislocations is limited to case reports and few retrospective studies. This justifies the need for a comprehensive review of this condition. Our purpose was to elaborate a review on the epidemiology, clinical and radiological presentation, and treatment techniques and approach to these neglected injuries. Middle-aged adults from 30 to 50 represent 73.8% of reported cases, and most of them are males (72.0%). The most affected level is C5-C6 (43.0%). While most delays are due to missed injuries (52.1%) and ineffective non-operative treatment (36.2%), the other reason for delay is negligence in seeking medical care (11.7%). Patients present with variable degrees of neurological deficit, persistent neck pain, and neck stiffness. Reported approaches and techniques to reduce and stabilize these injuries are highly variable and depend on the surgeon's judgment, experience, and preference. Fibrotic tissues and bony fusion around the dislocated facet joint contribute to the reduction challenge, and 77.0% of closed reduction attempts fail. Anterior and posterior approaches to the cervical spine are used selectively or in combination for surgical release, reduction, and stabilization. Despite the lack of standardized treatment guidelines and different approaches, most of the authors reported improvement in pain, balance, and neurology post-surgery. Starting with the posterior surgical approach aims to achieve reduction compared to the anterior approach which largely aims at spinal decompression. Given the existing controversies, the need for quality prospective studies to determine the best treatment approach for lower cervical facet dislocations presenting with delay is evident.
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Affiliation(s)
| | - Alex Mathias Buteera
- University of Rwanda College of Medicine and Health Sciences, P.O. Box 3286, Kigali, Rwanda
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Prasad GL. Traumatic irreducible non-Hangman's type bilateral C2-C3 high-grade facet dislocation: technical nuance. Br J Neurosurg 2023; 37:1387-1390. [PMID: 33263442 DOI: 10.1080/02688697.2020.1854683] [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: 09/18/2019] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Abstract
Majority of C2-C3 vertebral dislocations occur as in combination with bilateral pars fractures, also known as Hangman's fractures. Isolated C2-C3 facet dislocation without any associated C2 fracture is a very rare injury. One such case has been presented in this report. A 29-year male was involved in a road traffic accident (RTA) after which he developed midline neck pain. Following a minor neck manipulation at a hair salon 15 days after the RTA, his neck pain worsened and he developed quadriparesis. Imaging at the time of admission showed bilateral high-grade C2-C3 facet dislocations without any associated fracture of C2 vertebra. Due to non-reduction of the dislocation with skeletal traction, surgery was contemplated. Intraoperatively, the C2-C3 joint spaces were opened but only partial reduction could be achieved. Complete reduction was achieved only after opening of the C1-C2 joints was performed. Later, C2-C4 screw-rod constructs were placed. Patient achieved good outcome with resolution of symptoms. This report concludes that, in cases of delayed presentation of irreducible C2-C3 bilateral facet dislocations and non-reducibility by skeletal traction, opening of the C1-2 joints may need to be performed in addition to the C2-C3 joint spaces, in order to achieve complete reduction.
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Affiliation(s)
- G Lakshmi Prasad
- Department of Neurosurgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
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Judy BF, Tracz JA, Rincon-Torroella J, Ahmed AK, Witham TF. Reduction of cervicothoracic spondyloptosis in an ambulatory patient: when traction fails. Spinal Cord Ser Cases 2023; 9:46. [PMID: 37666812 PMCID: PMC10477183 DOI: 10.1038/s41394-023-00604-3] [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: 11/04/2022] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION Cervical spondyloptosis is a rare complication of high-energy trauma which often results in significant patient morbidity and mortality. The authors present a case of spondyloptosis of C7 over T1 with minimal radicular symptoms and otherwise complete spinal cord sparing. This case highlights the surgical challenges faced with cervical spondyloptosis and the techniques used when traction fails. CASE PRESENTATION A 21-year-old man with no significant past medical history presented after a high-speed motor vehicle collision with cervicothoracic pain and mild hand grip weakness in addition to numbness of the fourth and fifth digits bilaterally (American Spinal Injury Association Impairment Scale Grade D). Computed tomography imaging revealed spondyloptosis of C7 over T1, a fracture of the C2 vertebral body, and a burst fracture of C3. To relieve spinal cord compression and restore sagittal realignment, closed reduction was attempted, however this resulted in perching of the bilateral C7-T1 facets, leading to an open posterior approach. The patient underwent C7 laminectomy, bilateral C7-T1 facetectomy, and manual reduction using a Mayfield skull clamp followed by C2-T3 fixation. Postoperatively, pain was diminished, sensory disturbances were resolved and the patient was otherwise neurologically stable. DISCUSSION There is a role for closed traction for reduction of cervical spondyloptosis, however, its role is debated especially when the patient is predominately neurologically intact. In this setting, the spine surgeon may be required to change traction and operative strategies in order to minimize potentially harmful manipulation while restoring sagittal realignment and stabilizing the spine for preservation of neurological function.
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Affiliation(s)
- Brendan F Judy
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA.
| | - Jovanna A Tracz
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Timothy F Witham
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA.
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Yang C, Yang X. Early versus late surgical intervention for cervical spinal cord injury: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e33322. [PMID: 36961173 PMCID: PMC10035988 DOI: 10.1097/md.0000000000033322] [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: 02/19/2023] [Accepted: 02/28/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Acute traumatic cervical spinal cord injury (SCI) is a catastrophic event with substantial physical, emotional, and economic burdens to patients, families, and society. Spinal cord decompression is recommended for the treatment of acute SCI. However, the optimal surgical timing remains controversial. Therefore, we perform a protocol for systematic review and meta-analysis to compare the efficacy of early and late surgical intervention for acute SCI. METHODS This systematic review and meta-analysis follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols statement, which have been registered in advance in the International prospective register of systematic reviews (registration number: CRD42023397592). We will search the following databases for randomized controlled trials: the Cochrane Skin Group Trials Register, MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Chinese Biomedical Literature Database, Chinese Medical Current Content, and China National Knowledge Infrastructure. The risk of bias of the included studies will be appraised using the Cochrane Collaboration tool for randomized controlled trials. Statistical analysis will be performed using IBM SPSS Statistics (Armonk, NY). RESULT The results of this systematic review will be published in a peer-reviewed journal. CONCLUSION This systematic review will provide evidence regarding the optimal timing for spinal cord decompression in patients with acute SCI.
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Affiliation(s)
- Chaowei Yang
- Graduate School of Hebei North University, Zhangjiakou City, Hebei Province, China
| | - Xinming Yang
- The First Affiliated Hospital of Hebei North University, Zhangjiakou City, Hebei Province, China
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6
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Patel PD, Divi SN, Canseco JA, Donnally CJ, Galetta M, Vaccaro A, Schroeder GD, Hsu WK, Hecht AC, Dossett AB, Dhanota AS, Prasad SK, Vaccaro AR. Management of Acute Subaxial Trauma and Spinal Cord Injury in Professional Collision Athletes. Clin Spine Surg 2022; 35:241-248. [PMID: 34379610 DOI: 10.1097/bsd.0000000000001148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 11/07/2020] [Indexed: 11/25/2022]
Abstract
Sports-related acute cervical trauma and spinal cord injury (SCI) represent a rare but devastating potential complication of collision sport injuries. Currently, there is debate on appropriate management protocols and return-to-play guidelines in professional collision athletes following cervical trauma. While cervical muscle strains and sprains are among the most common injuries sustained by collision athletes, the life-changing effects of severe neurological sequelae (ie, quadriplegia and paraplegia) from fractures and SCIs require increased attention and care. Appropriate on-field management and subsequent transfer/workup at an experienced trauma/SCI center is necessary for optimal patient care, prevention of injury exacerbation, and improvement in outcomes. This review discusses the epidemiology, pathophysiology, clinical presentation, immediate/long-term management, and current return-to-play recommendations of athletes who suffer cervical trauma and SCI.
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Affiliation(s)
- Parthik D Patel
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
| | - Srikanth N Divi
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
| | - Chester J Donnally
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
| | - Matthew Galetta
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
| | - Alexander Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
| | - Wellington K Hsu
- Department of Orthopaedic Srugery, Northwestern University, Chicago, IL
| | - Andrew C Hecht
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Andrew B Dossett
- Department of Orthopaedic Surgery, The Carrell Clinic, Dallas, TX
| | - Arsh S Dhanota
- Department of Sports Medicine, Perelman School of Medicine at the University of Pennsylvania
| | - Srivinas K Prasad
- Department of Neurosurgery, Thomas Jefferson University, Phiadelphia, PA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Phiadelphia, PA
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7
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Hadhri K, Salah MB, Bellil M, Kooli M. Traumatic Floating Neural Arch of the Subaxial Cervical Spine: Case Report. Neurol India 2022; 70:1658-1660. [PMID: 36076678 DOI: 10.4103/0028-3886.355120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Bilateral traumatic pedicle fracture in the lower cervical spine is a very unusual lesion. Its association with bilateral facet dislocation has been reported once in the literature. We report a unique traumatic lesion considered as subaxial cervical floating neural arch with special emphasize on reduction maneuvers and surgical management. It was a case of bilateral C7 pedicle fracture with bilateral C6/C7 facet dislocation in a neurologically intact 70-year-old patient. Open posterior reduction with fixation followed by anterior fusion was performed with good functional and radiological outcomes at last follow up. The floating neural arch lesion is the combination of bilateral pedicle fracture and facet dislocation. The detection of such lesions imposes a two-stage surgery with open posterior reduction and anterior fusion.
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Affiliation(s)
- Khaled Hadhri
- Department of Orthopedics and Traumatology, Charles Nicolle's Hospital, Tunis, Tunisia
| | - Mohamed Ben Salah
- Department of Orthopedics and Traumatology, Charles Nicolle's Hospital, Tunis, Tunisia
| | - Mehdi Bellil
- Department of Orthopedics and Traumatology, Charles Nicolle's Hospital, Tunis, Tunisia
| | - Mondher Kooli
- Department of Orthopedics and Traumatology, Charles Nicolle's Hospital, Tunis, Tunisia
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8
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Zhang K, Chen H, Chen K, Yang P, Yang H, Mao H. O-Arm Navigated Cervical Pedicle Screw Fixation in the Treatment of Lower Cervical Fracture-Dislocation. Orthop Surg 2022; 14:1135-1142. [PMID: 35524652 PMCID: PMC9163967 DOI: 10.1111/os.13227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 01/12/2022] [Accepted: 01/19/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of cervical pedicle screw (CPS) placement with O-arm navigation in the treatment of lower cervical fracture-dislocation. METHODS A retrospective clinical study was performed involving 42 consecutive patients with lower cervical spine fracture-dislocation who underwent CPS fixation surgery with O-arm navigation (CPS group) or received conventional lateral mass screw (LMS) fixation surgery (LMS group) between August 2015 and August 2019. Accuracy of CPS position was evaluated by postoperative CT. The clinical parameters including preoperative and final follow-up Japanese Orthopaedic Association (JOA) score and American Spinal Injury Association (ASIA) Impairment Scale, preoperative Sub-axial Injury Classification (SLIC) score, number of fixation segments, operation time, intraoperative blood loss, injury mechanism, injury location, surgical complications were also assessed between the two groups. RESULTS In LMS group, the preoperative SLIC score was 7.5 ± 0.9, ASIA score improvement was 0.8 ± 0.5, JOA score improvement was 3.0 ± 1.8, mean operation time was 204 ± 89 min, intraoperative blood loss was 311 ± 127 ml. In CPS group, the preoperative SLIC score was 7.3 ± 1.2, ASIA score improvement was 0.9 ± 0.5, JOA score improvement was 3.2 ± 2.4, mean operation time is 241 ± 85 min, intraoperative blood loss is about 327 ± 120 ml. There was no significant difference in terms of above clinical parameters between the two groups (P > 0.05), the fixation segments in CPS group (3.5 ± 1.1) were less than that in LMS group (4.2 ± 0.7) (P = 0.037). The accuracy of CPS insertion was evaluated based on postoperative CT. Of all the 118 CPSs, 83 (70.3%) were defined as Grade 0; 27 (22.9%) as Grade 1; eight (6.8%) as Grade 2; and none as Grade 3. CPS malposition rate in this study was 6.8%. In this study, there was no direct intraoperative or postoperative complication caused by CPS or LMS insertion. All the operations were successfully completed in two groups. One of the patients in LMS group presented cerebrospinal fluid leak caused by bone fragment broken of the dural sac, which led to delayed incision healing. CPS group and LMS group both had two patients who suffered pulmonary infection after surgery. A total of 78.6% of the patients showed evidence of neurologic recovery. Satisfactory reduction was achieved in all cases and maintained throughout the follow-up duration. CONCLUSION In the treatment of lower cervical spine fracture-dislocation, cervical pedicle screw insertion with O-arm navigation is a safe and effective method for posterior fixation.
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Affiliation(s)
- Kai Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hao Chen
- Department of Orthopedic Surgery, Affiliated Hospital of Yangzhou University, Yangzhou, China.,Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
| | - Kangwu Chen
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Peng Yang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huilin Yang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haiqing Mao
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
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9
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Endo T, Suda K, Fukui T, Matsumoto S, Komatsu M, Ota M, Ushiku C, Yamane J, Minami A, Takahata M, Iwasaki N. Rare case of real-time observation of paralytic deterioration after cervical dislocation in the hyperacute phase. BMC Musculoskelet Disord 2022; 23:412. [PMID: 35501753 PMCID: PMC9059409 DOI: 10.1186/s12891-022-05345-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/20/2022] [Indexed: 11/19/2022] Open
Abstract
Background There have been no prior reports of real-time detailed records leading to complete quadriplegia immediately after fracture dislocation in high-energy trauma. Here, we report a case of cervical dislocation in which the deterioration to complete motor paralysis (modified Frankel B1) and complete recovery (Frankel E) could be monitored in real time after reduction in the hyperacute phase. Case presentation A 65-year-old man was involved in a car accident and sustained a dislocation at the C5/6 level (Allen–Ferguson classification: distractive flexion injury stage IV). His paralysis gradually deteriorated from Frankel D to C 2 hours after the injury and from Frankl C to B 5 hours after the injury. His final neurological status immediately before reduction was Frankel B1 (complete motor paralysis with sensation only in the perianal region). Reduction was completed within 6 h and 5 min after injury, and spinal fusion was subsequently performed. The patient exhibited rapid motor recovery immediately after surgery, and was able to walk independently on postoperative day 14. Conclusions This case suggests that there is a mixture of cases in which the spinal cord has not been catastrophically damaged, even if the patient has complete motor paralysis. Prompt reduction has the potential to improve neurological function in such cases.
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Affiliation(s)
- Tsutomu Endo
- Hokkaido Spinal Cord Injury Center, Higashi-4, Minami-1, Bibai, Hokkaido, 072-0015, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kitaku Kita-15 Nishi-7, Sapporo, Hokkaido, 060-8638, Japan
| | - Kota Suda
- Hokkaido Spinal Cord Injury Center, Higashi-4, Minami-1, Bibai, Hokkaido, 072-0015, Japan.
| | - Takafumi Fukui
- Hokkaido Spinal Cord Injury Center, Higashi-4, Minami-1, Bibai, Hokkaido, 072-0015, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kitaku Kita-15 Nishi-7, Sapporo, Hokkaido, 060-8638, Japan
| | - Satoko Matsumoto
- Hokkaido Spinal Cord Injury Center, Higashi-4, Minami-1, Bibai, Hokkaido, 072-0015, Japan
| | - Miki Komatsu
- Hokkaido Spinal Cord Injury Center, Higashi-4, Minami-1, Bibai, Hokkaido, 072-0015, Japan
| | - Masahiro Ota
- Hokkaido Spinal Cord Injury Center, Higashi-4, Minami-1, Bibai, Hokkaido, 072-0015, Japan
| | - Chikara Ushiku
- Hokkaido Spinal Cord Injury Center, Higashi-4, Minami-1, Bibai, Hokkaido, 072-0015, Japan
| | - Junichi Yamane
- Hokkaido Spinal Cord Injury Center, Higashi-4, Minami-1, Bibai, Hokkaido, 072-0015, Japan
| | - Akio Minami
- Hokkaido Spinal Cord Injury Center, Higashi-4, Minami-1, Bibai, Hokkaido, 072-0015, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kitaku Kita-15 Nishi-7, Sapporo, Hokkaido, 060-8638, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kitaku Kita-15 Nishi-7, Sapporo, Hokkaido, 060-8638, Japan
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10
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McDonald CL, Daniels AH, Anderson GA, Alsoof D, Kuris EO. Traumatic Cervical Facet Fractures and Dislocations. JBJS Rev 2022; 10:01874474-202205000-00005. [PMID: 35536995 DOI: 10.2106/jbjs.rvw.22.00023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Flexion-distraction, axial loading, and rotational forces can cause various degrees of osseoligamentous disruption of the cervical spine, leading to traumatic cervical facet fractures and dislocations. » Low-energy forces lead to minimally displaced facet fractures that often can be treated with immobilization only. High-energy forces are more likely to cause unstable injuries with or without neurologic compromise, which may require surgical intervention. » The initial treatment of cervical facet injuries requires patient evaluation and management through the Advanced Trauma Life Support (ATLS) protocols, while definitive management varies based on the biomechanical components of the injury, the neurologic status of the patient, and additional patient factors. » Cervical facet injuries often require a multidisciplinary approach to optimize long-term functional outcomes and minimize serious complications.
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Affiliation(s)
- Christopher L McDonald
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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11
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Lee D, Kawano K, Ishida S, Yamaguchi Y, Kuroki T, Nagai T, Higa K, Kurogi S, Hamanaka H, Ochiai H, Chosa E. The impact of helicopter emergency medical services and craniocervical traction on the early reduction of cervical spine dislocation in a rural area of Japan. J Orthop Sci 2022; 27:606-613. [PMID: 33933327 DOI: 10.1016/j.jos.2021.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/29/2021] [Accepted: 03/15/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Several studies have shown an association between achieving decompression of the spinal cord within a few hours and neurological recovery, even in patients with complete paralysis due to cervical spine dislocation. This study aimed to clarify the impact of helicopter emergency medical services (HEMSs) and craniocervical traction on the rapid reduction of lower cervical spine dislocation in rural Japan. METHODS The success rate of and factors inhibiting closed reduction, the time from injury to reduction and the functional prognosis of lower cervical spine dislocations treated between July 2012 and February 2020 were retrospectively analysed. RESULTS Fourteen patients were transported by HEMS (group H), seven by ambulance (group A) and two by themselves. Although the average traveled distance and injury severity score were significantly higher in group H (64.5 km, 28.0) than in group A (24.7 km, 18.6), there was no significant difference in the average time to admission or the time to initiation of craniocervical traction after admission between groups H (159.4 min, 52.2 min) and A (163.6 min, 53.2 min). The success rate of closed reduction was 95%, and neurological deterioration was not observed in any cases. The average traction time and weight for reduction were 30.3 min and 16.3 kg, respectively. Body size and fracture-dislocation type did not significantly affect the traction time or weight. The rate of reduction within 4 h after injury was higher in group H (79%) than in group A (33%). Inner fixations were treated an average of 5.7 days after admission. After treatment, three of nine AIS A patients recovered the ability to walk, and all three patients underwent successful closed reduction within 4 h after injury. CONCLUSION HEMS and highly successful closed reduction contributed to the early reduction of cervical spine dislocation and can potentially improve complete paralysis.
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Affiliation(s)
- Deokcheol Lee
- The Department of Orthopaedic Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan; Emergency Medicine, Acute Critical Care Center, University of Miyazaki Hospital, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
| | - Keisuke Kawano
- The Department of Orthopaedic Surgery, Miyazaki Prefectural Nobeoka Hospital, 2-1-10 Shinkouji, Nobeoka, 882-0835, Japan
| | - Shotaro Ishida
- The Department of Orthopaedic Surgery, Miyazaki Prefectural Nichinan Hospital, 1-9-5 Kiyama, Nichinan, 887-0013, Japan
| | - Yoichiro Yamaguchi
- The Department of Orthopaedic Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan; Emergency Medicine, Acute Critical Care Center, University of Miyazaki Hospital, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Tomofumi Kuroki
- The Department of Orthopaedic Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Takuya Nagai
- The Department of Orthopaedic Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Kiyoshi Higa
- The Department of Orthopaedic Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Syuji Kurogi
- The Department of Orthopaedic Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Hideaki Hamanaka
- The Department of Orthopaedic Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Hidenobu Ochiai
- Emergency Medicine, Acute Critical Care Center, University of Miyazaki Hospital, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Etsuo Chosa
- The Department of Orthopaedic Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
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12
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Humphrey T, Song J, Zhang A, Czerwein J, Chao S. Nonoperative Management of Chronically Subluxated Bilateral Cervical Facets with Bony Fusion: A Case Report. JBJS Case Connect 2022; 12:01709767-202203000-00025. [PMID: 35050939 DOI: 10.2106/jbjs.cc.21.00660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We describe a case of a 65-year-old woman with bilateral chronically subluxated C6 to 7 facets with facet fusion, who presented for care for the first time 1 year after a motor vehicle accident. The patient was minimally symptomatic at the time of her evaluation; thus, nonoperative treatment was provided. At 3-year follow-up, our patient remained minimally symptomatic with no progression of neurologic deficits. CONCLUSION Consistent with previous reports, conservative management was used rather than surgical fusion in a patient with stable osseous fusion complexes and minimal neurologic symptoms.
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Affiliation(s)
- Tyler Humphrey
- Department of Orthopaedic Surgery, Newton Wellesley Hospital, Newton, Massachusetts
| | - Junho Song
- Department of Orthopaedic Surgery, North Shore University Hospital-Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra University, New Hyde Park, New York
| | - Andrew Zhang
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - John Czerwein
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Simon Chao
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Damage Control Orthopaedics in Spinal Trauma. J Am Acad Orthop Surg 2021; 29:e1291-e1302. [PMID: 34874334 DOI: 10.5435/jaaos-d-21-00312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 09/02/2021] [Indexed: 02/01/2023] Open
Abstract
There has been a shift in the management of the polytrauma patients from early total care to damage control orthopaedics (DCO), whereby patients with borderline hemodynamic stability may be temporized with the use of external fixators, traction, or splinting with delayed osteosynthesis of fractures. Recently, there has been an increasing trend toward a middle ground approach of Early Appropriate Care for polytrauma patients. The concepts of DCO for the spine are less clear, and the management of trauma patients with combined pelvic ring and spinal fractures or patients with noncontiguous spinal injuries present unique challenges to the surgeon in prioritization of patient needs. This review outlines the concept of DCO and Early Appropriate Care in the spine, prioritizing patient needs from the emergency department to the operating room. Concepts include the timing of surgery, minimally invasive versus open techniques, and the prioritization of spinal injuries in the setting of other orthopaedic and nonorthopaedic injuries. Contiguous and noncontiguous spinal injuries are considered in construct planning, and the principles are discussed.
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14
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Chen YF, Luan GN, Li XJ, Peng Y, Li TF, Zhang HX, Li JY, Ma S, Li SL, Xue J, Du JJ. C2-C3 Anterior Cervical Diskectomy and Fusion for Hangman's Fractures with C2 Posterior Dislocation: Technical Notes. World Neurosurg 2021; 158:210-215. [PMID: 34838763 DOI: 10.1016/j.wneu.2021.11.084] [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: 10/05/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The overwhelming majority of hangman's fractures cause anterior dislocation of C2. Hangman's fracture with C2 posterior dislocation is extremely rare; only 1 pediatric case was reported in 2018 to date. This kind of injury cannot be cataloged using current classification schemes, and no established treatment recommendations exist. The purpose of this article is to report a rare case of a hangman's fracture with C2 posterior dislocation, which does not fit into existing classification systems and discuss management technical notes to avoid pitfalls. METHODS We describe this case, review relevant literature, and share our experience. RESULTS A 31-year-old male sustained a hangman's fracture with C2 posterior dislocation after he fell into a 50-cm deep roadside ditch when riding a motorcycle. Radiograph and computed tomography on admission showed fractures through both pars of C2 and C2 posterior dislocation. Magnetic resonance imaging on admission showed high T2-weighted signal intensity of cervical spinal cord and compression of the cervical spinal cord by posterior dislocation of the C2 vertebral body. A C2-3 anterior cervical diskectomy and fusion was performed. At 6 months after operation, bony fusion was achieved and magnetic resonance imaging showed the T2-weighted signal hyperintensity of cervical spinal cord before surgery disappeared. CONCLUSIONS C2-C3 anterior cervical diskectomy and fusion is recommended for hangman's fractures with C2 posterior dislocation. Traction before surgery is not recommended.
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Affiliation(s)
- Yu-Fei Chen
- Department of Orthopaedics, Air Force Medical Center of the People's Liberation Army, Beijing, People's Republic of China
| | - Guan-Nan Luan
- Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Xiao-Jie Li
- Department of Orthopaedics, Air Force Medical Center of the People's Liberation Army, Beijing, People's Republic of China
| | - Ye Peng
- Department of Orthopaedics, Air Force Medical Center of the People's Liberation Army, Beijing, People's Republic of China
| | - Teng-Fei Li
- Department of Orthopaedics, Air Force Medical Center of the People's Liberation Army, Beijing, People's Republic of China
| | - Hong-Xing Zhang
- Department of Orthopaedics, Air Force Medical Center of the People's Liberation Army, Beijing, People's Republic of China
| | - Jing-Yuan Li
- Department of Orthopaedics, Air Force Medical Center of the People's Liberation Army, Beijing, People's Republic of China
| | - Shuang Ma
- Department of Orthopaedics, Sanmenxia Yellow River Hospital, Henan, People's Republic of China
| | - Song-Lin Li
- Department of Orthopaedics, Air Force Medical Center of the People's Liberation Army, Beijing, People's Republic of China
| | - Jing Xue
- Department of Orthopaedics, Air Force Medical Center of the People's Liberation Army, Beijing, People's Republic of China
| | - Jun-Jie Du
- Department of Orthopaedics, Air Force Medical Center of the People's Liberation Army, Beijing, People's Republic of China.
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15
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Wilkerson C, Dailey AT. Spinal Cord Injury Management on the Front Line: ABCs of Spinal Cord Injury Treatment Based on American Association of Neurological Surgeons/Congress of Neurological Surgeons Guidelines and Common Sense. Neurosurg Clin N Am 2021; 32:341-351. [PMID: 34053722 DOI: 10.1016/j.nec.2021.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Spinal cord injury (SCI) affects approximately 54 per 1 million people annually in the United States. Treatment strategies for this patient population focus on initial stabilization and early intervention. The cornerstones of early management are clinical assessment, characterization of the injury, medical optimization, and definitive surgical treatment, including surgical stabilization and/or decompression. This article discusses the important strategies in caring for patients with SCI that are supported with significant literature.
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Affiliation(s)
- Christopher Wilkerson
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 North Medical Drive East, Salt Lake City, UT 84132, USA
| | - Andrew T Dailey
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 North Medical Drive East, Salt Lake City, UT 84132, USA.
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16
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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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17
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Lee W, Wong CC. Anterior-Alone Surgical Treatment for Subaxial Cervical Spine Facet Dislocation: A Systematic Review. Global Spine J 2021; 11:256-265. [PMID: 32875872 PMCID: PMC7882821 DOI: 10.1177/2192568220907574] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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 Systematic review. OBJECTIVE Anterior-alone surgery has gained wider reception for subaxial cervical spine facets dislocation. Questions remain on its efficacy and safety as a stand-alone entity within the contexts of concurrent facet fractures, unilateral versus bilateral dislocations, anterior open reduction, and old dislocation. METHODS A systematic review was performed with search strategy using translatable MESH terms across MEDLINE, EMBASE, VHL Regional Portal, and CENTRAL databases on patients with subaxial cervical dislocation intervened via anterior-alone approach. Two reviewers independently screened for eligible studies. PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) flow chart was adhered to. Nine retrospective studies were included. Narrative synthesis was performed to determine primary outcomes on spinal fusion and revisions and secondary outcomes on new occurrence or deterioration of neurology and infection rate. RESULTS Nonunion was not encountered across all contexts. A total of 0.86% of unilateral facet dislocation (1 out of 116) with inadequate reduction due to facet fragments between the facet joints removed its malpositioned plate following fusion. No new neurological deficit was observed. Cases that underwent anterior open reduction did not encounter failure that require subsequent posterior reduction surgery. One study (N = 52) on old dislocation incorporated partial corpectomy in their approach and limited anterior-alone approach to cases with persistent instability. CONCLUSIONS This systematic review supports the efficacy and success of anterior reduction, fusion, and instrumentation for cervical facet fracture dislocation. It is safe from a neurological standpoint. Revision rate due to concurrent facet fracture is low. Certain patients may require posteriorly based surgery or in specific cases combined anterior and posterior procedures.
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Affiliation(s)
- Wendy Lee
- Department of Orthopaedic Surgery, Sibu Hospital, Sarawak, Malaysia,Wendy Lee, Department of Orthopaedic Surgery, Clinical Research Center, Sibu Hospital, 5 1/2 Miles, Old Oya Road Sibu 96000 Malaysia.
| | - Chung Chek Wong
- Department of Orthopaedic Surgery, Sarawak General Hospital, Kuching, Sarawak, Malaysia
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18
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Rai HIS, Garg K, Agrawal D. Management of Traumatic Cervical Spondyloptosis. INDIAN JOURNAL OF NEUROTRAUMA 2021. [DOI: 10.1055/s-0040-1722554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractTraumatic cervical spondyloptosis is a 3-column fracture-dislocation resulting in a highly unstable spine requiring urgent reduction, stabilization, and fixation. Since its occurrence is not that common, there are a lot of controversies concerning its management. A holistic approach has been proposed regarding the management of traumatic cervical spondyloptosis.
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Affiliation(s)
- Hitesh Inder Singh Rai
- Department of Neurosurgery & Gamma-Knife, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery & Gamma-Knife, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Agrawal
- Department of Neurosurgery & Gamma-Knife, All India Institute of Medical Sciences, New Delhi, India
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19
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Zileli M, Osorio-Fonseca E, Konovalov N, Cardenas-Jalabe C, Kaprovoy S, Mlyavykh S, Pogosyan A. Early Management of Cervical Spine Trauma: WFNS Spine Committee Recommendations. Neurospine 2021; 17:710-722. [PMID: 33401852 PMCID: PMC7788428 DOI: 10.14245/ns.2040282.141] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/06/2020] [Indexed: 12/12/2022] Open
Abstract
Epidemiology, prevention, early management of cervical spine trauma and it's reduction are the objectives of this review paper. A PubMed and MEDLINE search between 2009 and 2019 were conducted using keywords. Case reports, experimental studies, papers other than English language and and unrelated studies were excluded. Up-to-date information on epidemiology of spine trauma, prevention, early emergency management, transportation, and closed reduction were reviewed and statements were produced to reach a consensus in 2 separate consensus meeting of World Federation of Neurosurgical Societies (WFNS) Spine Committee. The statements were voted and reached a positive or negative consensus using Delphi method. Global incidence of traumatic spinal injury is higher in low- and middle-income countries. The most frequent reasons are road traffic accidents and falls. The incidence from low falls in the elderly are increasing in high-income countries due to ageing populations. Prevention needs legislative, engineering, educational, and social efforts that need common efforts of all society. Emergency care of the trauma patient, transportation, and in-hospital acute management should be planned by implementing detailed protocols to prevent further damage to the spinal cord. This review summarizes the WFNS Spine Committee recommendations on epidemiology, prevention, and early management of cervical spine injuries.
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Affiliation(s)
- Mehmet Zileli
- Department of Neurosurgery, Ege University, Izmir, Turkey
| | | | - Nikolay Konovalov
- N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
| | | | - Stanislav Kaprovoy
- N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
| | - Sergey Mlyavykh
- Trauma and Orthopedics Institute, Privolzhsky Research Medical University, Nizhniy Novgorod, Russian Federation
| | - Artur Pogosyan
- N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
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20
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Patsakos EM, Craven BC, Kua A, Cheng CL, Eng J, Ho C, Noonan VK, Querée M, Bayley MT. Evaluation of the quality of published SCI clinical practice guidelines using the AGREE II instrument: Results from Can-SCIP expert panel. J Spinal Cord Med 2021; 44:S69-S78. [PMID: 34779735 PMCID: PMC8604538 DOI: 10.1080/10790268.2021.1961053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Spinal cord injury (SCI) is a complex condition with substantial adverse personal, social and economic impacts necessitating evidence-based inter-professional care. To date, limited studies have assessed the quality of clinical practice guidelines (CPGs) within SCI. The aim of this study is to evaluate the quality of the development process and methodological rigour of published SCI CPGs across the care continuum from pre-hospital to community-based care. METHODS Electronic health databases and indexes were searched to identify English or French language CPGs within SCI published within the last nine years with specific evidence-based recommendations applicable to the Canadian health care setting. Eligible CPGs were evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. RESULTS A total of forty-one CPGs that met the inclusion criteria were appraised by at least four raters. There was high variability in quality. Twenty-seven CPGs achieved a good rigour of development domain score of >70%. Other standardized mean domain scores were scope and purpose (85.32%), stakeholder involvement (65.03%), clarity of presentation (84.81%), applicability (55.55%) and editorial independence (75.83%). The agreement between appraisers (intraclass correlation coefficient) was high (intraclass correlation coefficient > 0.80). CONCLUSION There is a paucity of CPGs that address community-based specialized rehabilitation and community reintegration. Furthermore, many CPGs only focus on a single impairment at one time point in the care continuum. As SCI is a complex condition that results in multimorbidity and requires health monitoring and intervention across the lifespan, a rigorously developed CPG that addresses high-quality, interprofessional comprehensive care is needed.
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Affiliation(s)
- Eleni M. Patsakos
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - B. Catharine Craven
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ailene Kua
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Christiana l. Cheng
- Praxis Spinal Cord Institute, International Collaboration on Repair Discoveries (ICORD), University of British Columbia, British Columbia, Canada
| | - Janice Eng
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Chester Ho
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Alberta, Alberta, Canada
| | - Vanessa K. Noonan
- Praxis Spinal Cord Institute, International Collaboration on Repair Discoveries (ICORD), University of British Columbia, British Columbia, Canada
| | - Matthew Querée
- Department of Physiotherapy, Faculty of Medicine, University of British Columbia, GF Strong Rehabilitation Centre, British Columbia, Canada
| | - Mark T. Bayley
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - the Can-SCIP Guideline Expert Panel
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Praxis Spinal Cord Institute, International Collaboration on Repair Discoveries (ICORD), University of British Columbia, British Columbia, Canada
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, British Columbia, Canada
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Alberta, Alberta, Canada
- Department of Physiotherapy, Faculty of Medicine, University of British Columbia, GF Strong Rehabilitation Centre, British Columbia, Canada
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21
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Patsakos EM, Bayley MT, Kua A, Cheng C, Eng J, Ho C, Noonan VK, Querée M, Craven BC. Development of the Canadian Spinal Cord Injury Best Practice (Can-SCIP) Guideline: Methods and overview. J Spinal Cord Med 2021; 44:S52-S68. [PMID: 34779719 PMCID: PMC8604491 DOI: 10.1080/10790268.2021.1953312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Spinal cord injury (SCI) is a life-altering injury that leads to a complex constellation of changes in an individual's sensory, motor, and autonomic function which is largely determined by the level and severity of cord impairment. Available SCI-specific clinical practice guidelines (CPG) address specific impairments, health conditions or a segment of the care continuum, however, fail to address all the important clinical questions arising throughout an individual's care journey. To address this gap, an interprofessional panel of experts in SCI convened to develop the Canadian Spinal Cord Injury Best Practice (Can-SCIP) Guideline. This article provides an overview of the methods underpinning the Can-SCIP Guideline process. METHODS The Can-SCIP Guideline was developed using the Guidelines Adaptation Cycle. A comprehensive search for existing SCI-specific CPGs was conducted. The quality of eligible CPGs was evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. An expert panel (n = 52) convened, and groups of relevant experts met to review and recommend adoption or refinement of existing recommendations or develop new recommendations based on evidence from systematic reviews conducted by the Spinal Cord Injury Research Evidence (SCIRE) team. The expert panel voted to approve selected recommendations using an online survey tool. RESULTS The Can-SCIP Guideline includes 585 total recommendations from 41 guidelines, 96 recommendations that pertain to the Components of the Ideal SCI Care System section, and 489 recommendations that pertain to the Management of Secondary Health Conditions section. Most recommendations (n = 281, 48%) were adopted from existing guidelines without revision, 215 (36.8%) recommendations were revised for application in a Canadian context, and 89 recommendations (15.2%) were created de novo. CONCLUSION The Can-SCIP Guideline is the first living comprehensive guideline for adults with SCI in Canada across the care continuum.
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Affiliation(s)
- Eleni M. Patsakos
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Mark T. Bayley
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ailene Kua
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Christiana Cheng
- Praxis Spinal Cord Institute, International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Janice Eng
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Physiotherapy, GF Strong Rehabilitation Centre, Vancouver, British Columbia, Canada
| | - Chester Ho
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Vanessa K. Noonan
- Praxis Spinal Cord Institute, International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew Querée
- GF Strong Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - B. Catharine Craven
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Sjeklocha L, Gatz JD. Traumatic Injuries to the Spinal Cord and Peripheral Nervous System. Emerg Med Clin North Am 2020; 39:1-28. [PMID: 33218651 DOI: 10.1016/j.emc.2020.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Both blunt and penetrating trauma can cause injuries to the peripheral and central nervous systems. Emergency providers must maintain a high index of suspicion, especially in the setting of polytrauma. There are 2 major classifications of peripheral nerve injuries (PNIs). Some PNIs are classically associated with certain traumatic mechanisms. Most closed PNIs are managed conservatively, whereas sharp nerve transections require specialist consultation for urgent repair. Spinal cord injuries almost universally require computed tomography imaging; some require emergent magnetic resonance imaging. Providers should work to minimize secondary injury. Surgical specialists are needed for closed reduction, surgical decompression, or stabilization.
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Affiliation(s)
- Lucas Sjeklocha
- R Adams Cowley Shock Trauma Center, 22 South Greene Street, Room S4D03, Baltimore, MD 21201, USA
| | - J David Gatz
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
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Wang TY, Mehta VA, Dalton T, Sankey EW, Rory Goodwin C, Karikari IO, Shaffrey CI, Than KD, Abd-El-Barr MM. Biomechanics, evaluation, and management of subaxial cervical spine injuries: A comprehensive review of the literature. J Clin Neurosci 2020; 83:131-139. [PMID: 33281051 DOI: 10.1016/j.jocn.2020.11.004] [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: 08/18/2020] [Revised: 10/19/2020] [Accepted: 11/01/2020] [Indexed: 10/22/2022]
Abstract
STUDY DESIGN Literature review. OBJECTIVES It has been reported that 2.4-3.7% of all blunt trauma victims suffer some element of cervical spine fracture, with the majority of these patients suffering from C3-7 (subaxial) involvement. With the improvement of first-response to trauma in the community, there are an increasing number of patients who survive their initial trauma and thus arrive at the hospital in need of further evaluation, stabilization, and management of these injuries. METHODS A comprehensive literature review compiled all relevant data on the biomechanics, imaging, evaluation, and medical and surgical management strategies for subaxial cervical spine fractures. RESULTS After review of the current literature on subaxial cervical spine biomechanics, imaging characteristics, evaluation strategies and surgical and orthopedic management techniques, the authors created a comprehensive review and protocol for management of subaxial cervical spine fractures. CONCLUSIONS The subaxial cervical spine is biomechanically and anatomically unique from the remainder of the spinal axis. Evaluation of subaxial cervical spine injuries is nuanced, and improper management of these injuries can lead to significant patient morbidity and even death. This provides a comprehensive review combining anatomy, imaging characteristics, evaluation strategies, and surgical and orthopedic management principles for subaxial cervical spine fractures.
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Affiliation(s)
- Timothy Y Wang
- Departments of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Vikram A Mehta
- Departments of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Tara Dalton
- Departments of Neurosurgery, Duke University Medical Center, Durham, NC, USA; Duke University School of Medicine, Durham, NC, USA
| | - Eric W Sankey
- Departments of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - C Rory Goodwin
- Departments of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Isaac O Karikari
- Departments of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | | | - Khoi D Than
- Departments of Neurosurgery, Duke University Medical Center, Durham, NC, USA
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Li Y, Huang M, Manzano G. Traumatic dorsal spondyloptosis of upper thoracic spine: case report and novel open reduction technique. Br J Neurosurg 2020; 37:1-5. [PMID: 33030074 DOI: 10.1080/02688697.2020.1828277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
Traumatic thoracic spondyloptosis represents a rare but potentially catastrophic spinal injury pattern. We present a unique case of a 37-year-old male who suffered a high-thoracic retroloptosis with resultant complete spinal cord injury following a motor vehicle accident. We describe a novel and effective method of open reduction utilising horizontally oriented temporary rods facilitating controlled, sequential sagittal distraction and unlocking, reversal of anteroposterior shear and restoration of alignment. Using our technique, successful reduction and realignment was achieved.
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Affiliation(s)
- Yingda Li
- Department of Neurological Surgery, University of Miami Miller School of Medicine Lois Pope LIFE Centre, Miami, FL, USA
| | - Meng Huang
- Department of Neurological Surgery, University of Miami Miller School of Medicine Lois Pope LIFE Centre, Miami, FL, USA
| | - Glen Manzano
- Department of Neurological Surgery, University of Miami Miller School of Medicine Lois Pope LIFE Centre, Miami, FL, USA
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25
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Wu Y, Shao X, Wang X, Zeng J. An Experimental Study on the Safety and Mechanism of Reduction of Subaxial Cervical Facet Dislocation Using Z-Shape Elevating-Pulling Reduction Technique. World Neurosurg 2020; 142:e364-e371. [PMID: 32673803 DOI: 10.1016/j.wneu.2020.06.234] [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: 02/07/2020] [Revised: 06/27/2020] [Accepted: 06/30/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We sought to clarify the safety and unlocking mechanism of the Z-shape elevating-pulling closed reduction (ZR) technique and to analyze the differences in facet contact force and intraspinal pressure during subaxial facet dislocation reduction using the ZR technique and traditional skull traction closed reduction (SR). METHODS In 15 human cadaveric skull-neck-thorax specimens, reproducible unilateral and bilateral facet dislocations (UFDs/BFDs) were created at the C5-C6 level and then reduced by applying the ZR and SR techniques, respectively. Tekscan FlexiForce A-201 pressure sensors were used to measure the anterior and posterior intraspinal pressure and injured facet contact force under physiological conditions and before and after reduction. The maximum pressures during the reduction process were recorded. RESULTS After creation of the facet dislocation, the anterior and posterior intraspinal pressure and facet contact force were significantly increased relative to normal (P < 0.001). The UFDs and BFDs of all specimens were successfully reduced by both ZR and SR, and the intraspinal pressure and facet contact force were significantly reduced compared with before reduction (P < 0.001). Compared with SR, the maximum posterior intraspinal pressure during BFD reduction (P = 0.027) and the maximum facet contact force during UFD reduction (P < 0.001) were lower when ZR was used for closed reduction. CONCLUSIONS Our findings suggest that ZR and SR can both be used to reduce subaxial facet dislocation and decompress the spinal cord. However, the ZR technique appears to safer and more effective than the SR technique for closed reduction of subaxial facet dislocations.
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Affiliation(s)
- Ye Wu
- Department of Spine Surgery, Second Affiliated Hospital, Shantou University Medical College, Shantou, People's Republic of China
| | - Xinwei Shao
- Department of Spine Surgery, Second Affiliated Hospital, Shantou University Medical College, Shantou, People's Republic of China
| | - Xinjia Wang
- Department of Spine Surgery, Second Affiliated Hospital, Shantou University Medical College, Shantou, People's Republic of China.
| | - Jican Zeng
- Department of Spine Surgery, Second Affiliated Hospital, Shantou University Medical College, Shantou, People's Republic of China
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Sturdà C, Offi M, Silvestri M, Visocchi M. Old Perched Facet Joint Syndrome: "The Always-Anterior Strategy." Report of Two Cases and Review of the Literature. World Neurosurg 2020; 142:460-464. [PMID: 32673805 DOI: 10.1016/j.wneu.2020.05.147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Perched facet joint syndrome is a common post-traumatic condition encountered at the level of subaxial cervical spine in acute settings but more rarely found in a chronic manner. We define this dislocation as old subaxial cervical facet dislocation (OSCFD) when adequate treatment is not established within 3 weeks after initial trauma. It is a clinical entity, moreover, associated with significant impact on neurologic functions such as nerve root or spine compression. Many factors are attributed to explain delayed diagnosis, such as living in a developing country, misreading or inadequate imaging, the presence of multiple injuries, or an absence of symptoms at the time of trauma. CASE DESCRIPTION We report 2 typical examples of long-lasting OSCFD (up to 6 months), treated both by an anterior cervical approach but with 2 different surgical strategies, associated with similar subsequent clinical restoration and neuroradiologic realignment. We also review the related literature regarding the mechanisms underlying this unusual observation and varied surgical strategies adopted, finally explaining the reasons for our choosing the always-anterior strategy. CONCLUSIONS In OSCFD, performing a vertebral canal decompression and realignment of the cervical spine column is crucial. More options are purposed to treat this challenging condition, and more of them could be complicated by time-consuming resetting in the operating room, prolonged anesthesiologic procedures, and elevated risk of 360° instrumentation surgical maneuvers. The one-stage combined anterior-approach only (corpectomy or discectomy) is an effective, fast, and safe surgical strategy for treating OSCFD.
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Affiliation(s)
- Cosimo Sturdà
- Institute of Neurosurgery, Fondazione Policlinico "A. Gemelli," Catholic University, Largo F. Vito, Rome, Italy.
| | - Martina Offi
- Institute of Neurosurgery, Fondazione Policlinico "A. Gemelli," Catholic University, Largo F. Vito, Rome, Italy
| | - Martina Silvestri
- Institute of Neurosurgery, Fondazione Policlinico "A. Gemelli," Catholic University, Largo F. Vito, Rome, Italy
| | - Massimiliano Visocchi
- Institute of Neurosurgery, Fondazione Policlinico "A. Gemelli," Catholic University, Largo F. Vito, Rome, Italy; Craniovertebral Junction Operative Unit and Master CVJ Surgical Approach Research Center, Fondazione Policlinico "A. Gemelli," Catholic University, Largo F. Vito, Rome, Italy
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Abstract
Acute traumatic spinal cord injury (SCI) affects more than 250,000 people in the USA, with approximately 17,000 new cases each year. It continues to be one of the most significant causes of trauma-related morbidity and mortality. Despite the introduction of primary injury prevention education and vehicle safety devices, such as airbags and passive restraint systems, traumatic SCI continues to have a substantial impact on the healthcare system. Over the last three decades, there have been considerable advancements in the management of patients with traumatic SCI. The advent of spinal instrumentation has improved the surgical treatment of spinal fractures and the ability to manage SCI patients with spinal mechanical instability. There has been a concomitant improvement in the nonsurgical care of these patients with particular focus on care delivered in the pre-hospital, emergency room, and intensive care unit (ICU) settings. This article represents an overview of the critical aspects of contemporary traumatic SCI care and notes areas where further research inquiries are needed. We review the pre-hospital management of a patient with an acute SCI, including triage, immobilization, and transportation. Upon arrival to the definitive treatment facility, we review initial evaluation and management steps, including initial neurological assessment, radiographic assessment, cervical collar clearance protocols, and closed reduction of cervical fracture/dislocation injuries. Finally, we review ICU issues including airway, hemodynamic, and pharmacological management, as well as future directions of care.
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Hadley MN, Walters BC. The case for the future role of evidence-based medicine in the management of cervical spine injuries, with or without fractures. J Neurosurg Spine 2019; 31:457-463. [PMID: 31574462 DOI: 10.3171/2019.6.spine19652] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 06/19/2019] [Indexed: 11/06/2022]
Abstract
The authors believe that the standardized and systematic study of immobilization techniques, diagnostic modalities, medical and surgical treatment strategies, and ultimately outcomes and outcome measurement after cervical spinal trauma and cervical spinal fracture injuries, if performed using well-designed medical evidence-based comparative investigations with meaningful follow-up, has both merit and the remarkable potential to identify optimal strategies for assessment, characterization, and clinical management. However, they recognize that there is inherent difficulty in attempting to apply evidence-based medicine (EBM) to identify ideal treatment strategies for individual cervical fracture injuries. First, there is almost no medical evidence reported in the literature for the management of specific isolated cervical fracture subtypes; specific treatment strategies for specific fracture injuries have not been routinely studied in a rigorous, comparative way. One of the vulnerabilities of an evidenced-based scientific review in spinal cord injury (SCI) is the lack of studies in comparative populations and scientific evidence on a given topic or fracture pattern providing level II evidence or higher. Second, many modest fracture injuries are not associated with vascular or neural injury or spinal instability. The application of the science of EBM to the care of patients with traumatic cervical spine injuries and SCIs is invaluable and necessary. The dedicated multispecialty author groups involved in the production and publication of the two iterations of evidence-based guidelines on the management of acute cervical spine and spinal cord injuries have provided strategic guidance in the care of patients with SCIs. This dedicated service to the specialty has been carried out to provide neurosurgical colleagues with a qualitative review of the evidence supporting various aspects of care of these patients. It is important to state and essential to understand that the science of EBM and its rigorous application is important to medicine and to the specialty of neurosurgery. It should be embraced and used to drive and shape investigations of the management and treatment strategies offered patients. It should not be abandoned because it is not convenient or it does not support popular practice bias or patterns. It is the authors' view that the science of EBM is essential and necessary and, furthermore, that it has great potential as clinician scientists treat and study the many variations and complexities of patients who sustain acute cervical spine fracture injuries.
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Affiliation(s)
- Mark N Hadley
- 1Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
| | - Beverly C Walters
- 1Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
- 2Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
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Sacino A, Rosenblatt K. Early Management of Acute Spinal Cord Injury-Part I: Initial Injury to Surgery. JOURNAL OF NEUROANAESTHESIOLOGY AND CRITICAL CARE 2019; 6:213-221. [PMID: 34012997 DOI: 10.1055/s-0039-1694688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Acute spinal cord injury is a devastating event associated with substantial morbidity worldwide. The pathophysiology of spinal cord injury involves the initial mechanical trauma and the subsequent inflammatory response, which may worsen the severity of neurologic dysfunction. Interventions have been studied to reduce the extent of primary injury to the spinal cord through preventive measures and to mitigate secondary insult through early specialized care. Management, therefore, is multifold, interdisciplinary, and begins immediately at the time of injury. It includes the trauma triage, acute management of the circulatory and respiratory systems, and definitive treatment, mainly with surgical decompression and stabilization.
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Affiliation(s)
- Amanda Sacino
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Kathryn Rosenblatt
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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Tanaka C, Tagami T, Kaneko J, Fukuda R, Nakayama F, Sato S, Takehara A, Kudo S, Kuno M, Kondo M, Unemoto K. Early versus late surgery after cervical spinal cord injury: a Japanese nationwide trauma database study. J Orthop Surg Res 2019; 14:302. [PMID: 31488166 PMCID: PMC6729069 DOI: 10.1186/s13018-019-1341-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The management of cervical spinal cord injury (SCI) has changed drastically in the last decades, and surgery is the primary treatment. However, the optimum timing of early surgical treatment (within 24 h or 72 h after injury) is still controversial. We sought to determine the optimum timing of surgery for cervical SCI, comparing the length of the intensive care unit (ICU) stay and in-hospital mortality in patients who underwent surgical treatments (decompression and stabilization) for cervical SCI within 24 h after injury and within 7 days after injury. METHODS This was a retrospective cohort study using Japan Trauma Data Bank (JTDB) which is a nationwide, multicenter database. We selected adult isolated cervical SCI patients who underwent operative management within 7 days after injury, between 2004 and 2015. The main outcome measures were the length of ICU stay and in-hospital mortality. We grouped the patients into two, based on the time from onset of injury to surgery, an early group (within 24 h) and a late group (from 25 h to 7 days). Next, we performed multivariable analyses for analyzing the relevance between the timing of surgery and the length of ICU stay after adjusting for baseline characteristics using propensity score. We also performed the Cox survival analyses to evaluate in-hospital mortality. RESULTS From 236,698 trauma patients registered in JTDB, we analyzed 514 patients. The early group comprised 291 patients (56.6%), and the late group comprised 223 (43.4%). The length of ICU stay did not differ between the two groups (early, 10 days; late, 11 days; p = 0.29). There was no significant difference for length of ICU stay between the early and late group even after adjustment by multivariate analysis (p = 0.64). There was no significant difference in in-hospital mortality between the two groups (the early group 3.8%, the late group 2.2%, p = 0.32), and no significant difference was found in the Cox survival analysis. CONCLUSIONS Our study showed that neither the length of ICU stay nor in-hospital mortality after spinal column stabilization or spinal cord decompression for cervical SCI significantly differed according to the timing of surgery between 24 h and 7 days.
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Affiliation(s)
- Chie Tanaka
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512 Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512 Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033 Japan
| | - Junya Kaneko
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512 Japan
| | - Reo Fukuda
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512 Japan
| | - Fumihiko Nakayama
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512 Japan
| | - Shin Sato
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512 Japan
| | - Akiko Takehara
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512 Japan
| | - Saori Kudo
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512 Japan
| | - Masamune Kuno
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512 Japan
| | - Masayoshi Kondo
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512 Japan
| | - Kyoko Unemoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512 Japan
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Yang JS, Wang XF, Zhao K, Liu P, Liu TJ, Chen CM, Hao DJ, Chu L. Posterior Unlocking of Facet Joints Under Endoscopy Followed by Anterior Decompression, Reduction, and Fixation of Old Subaxial Cervical Facet Dislocations: A Technical Note. World Neurosurg 2019; 130:179-186. [PMID: 31299305 DOI: 10.1016/j.wneu.2019.06.239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/28/2019] [Accepted: 06/29/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Besides the facet joints interlocking, the fibrous tissue or bony callus around the dislocated segments make the reduction for this kind of old injury to be more challenging and different from that of acute injuries. This study is aimed to present 4 cases of old subaxial cervical facet dislocations (SCFD) that were successfully treated with posterior unlocking under endoscopy followed by anterior decompression, reduction, and fixation. METHODS Between January 2017 and December 2017, 4 patients with old SCFD who underwent posterior unlocking of facet joints under endoscopy followed by anterior decompression, reduction, and fixation were enrolled. A cervical collar was prescribed for 4 weeks postoperatively. Postoperative follow-up evaluations were conducted at 2, 6, and 12 months, including neck visual analogue scale score and neck disability index, radiography, and computed tomography. RESULTS The operative time averaged 145 minutes (range, 130-155 minutes). No deterioration of neural function, major vessel rupture, or iatrogenic injury to esophagus occurred. Intraoperative blood loss averaged 45 mL (range, 40-50 mL). Hospital stay for all patients was only 4 days. The neck visual analogue scale score and neck disability index were improved at the final follow-up, and interbody fusion was satisfactory without any radiologic sign of instability or internal failure. CONCLUSIONS For patients with old SCFD, the unlocking of facet joints via the posterior approach under endoscopy followed by anterior decompression, reduction, and fixation is an alternative technique.
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Affiliation(s)
- Jun-Song Yang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiang-Fu Wang
- Department of Spinal Minimally Invasive Surgery, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, Gansu, China
| | - Kai Zhao
- Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Peng Liu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Tuan-Jiang Liu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Chien-Min Chen
- Department of Neurosurgery, Changhua Christian Hospital, Changhua City, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and College of Nursing and Health Sciences, Dayeh University, Changhua City, Taiwan
| | - Ding-Jun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| | - Lei Chu
- Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Shimizu T, Yoshioka K, Murakami H, Demura S, Kato S, Yokogawa N, Oku N, Kitagawa R, Tsuchiya H. Fluoroscopy-assisted posterior percutaneous reduction for the management of unilateral cervical facet dislocations after unsuccessful closed reduction: A case report. Int J Surg Case Rep 2019; 58:212-215. [PMID: 31078994 PMCID: PMC6515557 DOI: 10.1016/j.ijscr.2019.04.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/06/2019] [Accepted: 04/16/2019] [Indexed: 11/29/2022] Open
Abstract
Open reduction of cervical facet dislocation is needed when closed reduction fails. Anterior cervical discectomy and fusion after posterior percutaneous reduction was performed. Posterior percutaneous reduction can be useful for cervical facet dislocations.
Introduction In some cases of cervical facet dislocations, open reduction becomes imperative when closed reduction fails. In these cases, posterior open reduction with subsequent posterior fixation has been favored in previous reports as reduction using the posterior approach is less challenging than that using the anterior approach. However, it invades the posterior cervical muscles, is associated with a high risk of postoperative axial neck pain, and is less likely to restore cervical lordosis than anterior surgery. In this report, we describe a novel reduction technique, posterior percutaneous reduction, which can address this dilemma. Presentation of case An attempt to perform closed reduction in a 19-year-old adolescent with a unilateral facet dislocation at the C4-C5 level was unsuccessful. To preserve the posterior cervical muscles and obtain good cervical alignment, we opted for posterior percutaneous reduction and subsequent anterior cervical discectomy and fusion instead of posterior open reduction and fixation. An elevator was inserted into the locked facet percutaneously with fluoroscopic assistance, and reduction was achieved by lever action. Seven days after the percutaneous reduction, anterior cervical discectomy and iliac bone grafting with plate fixation were performed. There were no complications or neurological deficits postoperatively. Discussion This report describes the case of a patient who underwent anterior cervical discectomy and fusion after posterior percutaneous reduction with preservation of the posterior cervical muscles for unilateral facet dislocation when closed reduction was unsuccessful. conclusion Posterior percutaneous reduction could be a useful option for the management of cervical facet dislocations.
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Affiliation(s)
- Takaki Shimizu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
| | - Katsuhito Yoshioka
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Satoru Demura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Satoshi Kato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Noriaki Yokogawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Norihiro Oku
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Ryo Kitagawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
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Immediate anterior open reduction and plate fixation in the management of lower cervical dislocation with facet interlocking. Sci Rep 2019; 9:1286. [PMID: 30718730 PMCID: PMC6362197 DOI: 10.1038/s41598-018-37742-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 12/12/2018] [Indexed: 11/23/2022] Open
Abstract
Lower cervical dislocation with facet interlocking is one of the most drastic injuries to the cervical spine. The early reduction is thought critical in preventing progressive secondary spinal cord injury. The authors report a new surgical procedure in the management of lower cervical dislocation with facet interlocking. A total of twenty-one cases received immediate single-staged anterior open reduction, realignment and plate fixation under general anesthesia. After the procedures, most cases exhibited improved neurological function. All patients showed stable fusion at 1-year follow-up. Loss of spinal alignment or kyphotic deformity was not found in any case. Hardware failure including screw loosening or penetrating was not observed. In conclusion, the immediate anterior open reduction and plate fixation is a safe and effective procedure in the management of lower cervical dislocation with facet interlocking.
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Kim MW, Lee SB, Park JH. Cervical Spondyloptosis Successfully Treated with Only Posterior Short Segment Fusion Using Cervical Pedicle Screw Fixation. Neurol Med Chir (Tokyo) 2018; 59:33-38. [PMID: 30555121 PMCID: PMC6349999 DOI: 10.2176/nmc.tn.2018-0213] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
This paper describes two patients with cervical spondyloptosis with severe spinal cord injury treated with cervical pedicle screw (CPS) through a single-stage operation, posterior approach. A 60-year-old male patient with quadriparesis due to trauma 1 day before visited the emergency room. Cervical spine computed tomography (CT) and magnetic resonance imaging showed complete dislocation of the C7 and T1 vertebrae with severe spinal cord compression, disc injury, and disc herniation at the C7–T1 level. Cervical pedicle screw with freehand technique was done on C6 and T1 vertebrae, and bilateral distraction for a reduction was performed with a screw distractor. After reduction of the C7 vertebra on the surgical field, CPS placement on C7 body was done. After surgery, follow-up X-rays showed near complete reduction. The patient completed a rehabilitation program, and his condition improved. From the third month postoperatively, the patient could ambulate without assistance and perform nearly normal daily activities. A postoperative CT scan 1 year later showed accurate screw position and complete fusion bridges on the C6–C7–T1 vertebrae. The other patient, a 39-year-old male, also showed C7–T1 spondyloptosis with quadriparesis (grade IV). C6–T1–T2 fusion surgery was performed only through a posterior approach. The patient showed nearly normal neurology and reduction. Considering early surgery time followed by open reduction and biomechanical superiority of CPS, single posterior approach and short segment fusion appear to be a great surgical method.
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Affiliation(s)
- Min Woo Kim
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Su Bum Lee
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Jin Hoon Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine
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Rapid incremental closed traction reduction of cervical facet fracture dislocation: the Stoke Mandeville experience. Spinal Cord Ser Cases 2018; 4:86. [PMID: 30275978 DOI: 10.1038/s41394-018-0109-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 06/27/2018] [Accepted: 07/06/2018] [Indexed: 11/08/2022] Open
Abstract
Study design Retrospective case series study. Objective To determine the success rate and neurological outcomes of rapid incremental closed traction reduction (RICTR) of cervical dislocations with spinal cord compression in the National Spinal Injuries Centre (NSIC), between June 2006 and December 2011. Setting Tertiary spinal injuries centre, Stoke Mandeville Hospital, UK. Methods A list of cervical trauma patients who were admitted to NSIC between January 2006 and December 2011 was retrieved from the hospital's electronic records, consultant and admission logbooks. Patients, admitted within 7 days of cervical facet dislocation and spinal cord injury (SCI), were included. Retrospective data collection and analysis was done using a data collection form and an Excel spreadsheet. Results Seventeen patients have met the eligibility criteria of the study. One patient was excluded because he only had nerve root symptoms. The procedure was successful in 44% of the cases. Eighty-six percent of patients in the successful RICTR group improved in their discharge motor index score (MIS), whereas 43% improved in their post-reduction MIS. Overall, 81% of the cohort had improvements in their discharge MIS. Conclusion Our RICTR success rate was low compared to the reported average success rate in the literature, likely due to delays in admission. Neurological outcomes were favourable in the majority of patients at discharge. In our opinion, early admission and RICTR attempts could have improved the results and therefore we would recommend that RICTR procedures are done for suitable patients in the Emergency Departments of Major Trauma Centres (MTC).
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Branche MJ, Ozturk AK, Ramayya AG, McShane BJ, Schuster JM. Neurologic Status on Presentation as Predictive Measurement in Success of Closed Reduction in Traumatic Cervical Facet Fractures. World Neurosurg 2018. [PMID: 29530687 DOI: 10.1016/j.wneu.2018.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dislocations to cervical facets resulting from traumatic injury often lead to neurologic impairment and can be treated both surgically and in a closed manner. OBJECTIVE We sought to evaluate the utilization of closed reduction in the initial management of bilateral facet dislocations over the past 10 years at our institution. METHODS We retrospectively reviewed the charts of patients who experienced subaxial cervical facet injury within the Penn Health System between 1 June 2006 and 1 June 2016 to identify patients with bilateral jumped/perched facets. The neurologic injury was identified on the basis of the American Spinal Injury Association (ASIA) spinal cord injury score. Analysis of variance and 2-sample t-tests were used to compare continuous distributions, and chi-square tests were used to compare categorical distributions. RESULTS We focused our analyses on patients who presented with bilateral jumped/perched facets with (ASIA A and B) or without (ASIA C, D, E) complete voluntary motor deficit and underwent attempted closed reduction. We found that the rate of successful closed reduction was significantly higher in incomplete motor deficits (5/5, P = 0.04, chi-square test) as compared with complete motor deficits (n = 2/11). CONCLUSION Our results demonstrate a significant difference in the success rate of closed reduction in patients with good neurologic status on presentation (ASIA A or B), compared with those with poor neurologic status (ASIA C, D, and E). These results suggest that closed reduction should be attempted in patients with good motor examinations on presentation, whereas those with significant deficits may benefit from earlier surgical intervention.
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Affiliation(s)
- Marc J Branche
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ali K Ozturk
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ashwin G Ramayya
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brendan J McShane
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - James M Schuster
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Theodotou CB, Ghobrial GM, Middleton AL, Wang MY, Levi AD. Anterior Reduction and Fusion of Cervical Facet Dislocations. Neurosurgery 2018; 84:388-395. [DOI: 10.1093/neuros/nyy032] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 01/23/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christian B Theodotou
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - George M Ghobrial
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - Andrew L Middleton
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - Michael Y Wang
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - Allan D Levi
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
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Fehlings MG, Martin AR, Tetreault LA, Aarabi B, Anderson P, Arnold PM, Brodke D, Burns AS, Chiba K, Dettori JR, Furlan JC, Hawryluk G, Holly LT, Howley S, Jeji T, Kalsi-Ryan S, Kotter M, Kurpad S, Kwon BK, Marino RJ, Massicotte E, Merli G, Middleton JW, Nakashima H, Nagoshi N, Palmieri K, Singh A, Skelly AC, Tsai EC, Vaccaro A, Wilson JR, Yee A, Harrop JS. A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Role of Baseline Magnetic Resonance Imaging in Clinical Decision Making and Outcome Prediction. Global Spine J 2017; 7:221S-230S. [PMID: 29164028 PMCID: PMC5684845 DOI: 10.1177/2192568217703089] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The objective of this guideline is to outline the role of magnetic resonance imaging (MRI) in clinical decision making and outcome prediction in patients with traumatic spinal cord injury (SCI). METHODS A systematic review of the literature was conducted to address key questions related to the use of MRI in patients with traumatic SCI. This review focused on longitudinal studies that controlled for baseline neurologic status. A multidisciplinary Guideline Development Group (GDG) used this information, their clinical expertise, and patient input to develop recommendations on the use of MRI for SCI patients. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as "we recommend," whereas a weaker recommendation is indicated by "we suggest." RESULTS Based on the limited available evidence and the clinical expertise of the GDG, our recommendations were: (1) "We suggest that MRI be performed in adult patients with acute SCI prior to surgical intervention, when feasible, to facilitate improved clinical decision-making" (quality of evidence, very low) and (2) "We suggest that MRI should be performed in adult patients in the acute period following SCI, before or after surgical intervention, to improve prediction of neurologic outcome" (quality of evidence, low). CONCLUSIONS These guidelines should be implemented into clinical practice to improve outcomes and prognostication for patients with SCI.
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Affiliation(s)
- Michael G. Fehlings
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- Michael G. Fehlings, MD, PhD, FRCSC, FACS, Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst Street (SCI-CRU, 11th Floor McLaughlin Pavilion), Toronto, Ontario M5T 2S8, Canada.
| | - Allan R. Martin
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Lindsay A. Tetreault
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- University College Cork, Cork, Ireland
| | | | | | - Paul M. Arnold
- University of Kansas Medical Center, The University of Kansas, Kansas City, KS, USA
| | | | - Anthony S. Burns
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | | | | | - Julio C. Furlan
- University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | | | | | - Susan Howley
- Christopher & Dana Reeve Foundation, Short Hills, NJ, USA
| | - Tara Jeji
- Ontario Neurotrauma Foundation, Toronto, Ontario, Canada
| | | | | | | | - Brian K. Kwon
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Eric Massicotte
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Geno Merli
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | | | - Narihito Nagoshi
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Keio University, Keio, Japan
| | | | - Anoushka Singh
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | | | - Eve C. Tsai
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Jefferson R. Wilson
- University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Albert Yee
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Ohya J, Bray DP, Magill ST, Vogel TD, Berven S, Mummaneni PV. Mini-open anterior approach for cervicothoracic junction fracture: technical note. Neurosurg Focus 2017; 43:E4. [PMID: 28760037 DOI: 10.3171/2017.5.focus17179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Elderly patients with diffuse idiopathic skeletal hyperostosis are at high risk for falls, and 3-column unstable fractures present multiple challenges. Unstable fractures across the cervicothoracic junction are associated with significant morbidity and require fixation, which is commonly performed through a posterior open or percutaneous approach. The authors describe a novel, navigated, mini-open anterior approach using intraoperative cone-beam CT scanning to place lag screws followed by an anterior plate in a 97-year-old patient. This approach is less invasive and faster than an open posterior approach and can be considered as an option for management of cervicothoracic junction fractures in elderly patients with high perioperative risk profile who cannot tolerate being placed prone during surgery.
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Affiliation(s)
| | - David P Bray
- Department of Neurosurgery, Emory University Medical Center, Atlanta, Georgia
| | | | | | - Sigurd Berven
- Orthopedic Surgery, University of California, San Francisco, California; and
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40
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Affiliation(s)
- Alexander E Ropper
- From the Department of Neurosurgery, Baylor College of Medicine, Houston (A.E.R.)
| | - Allan H Ropper
- From the Department of Neurosurgery, Baylor College of Medicine, Houston (A.E.R.)
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41
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‘Split and splayed C3’—traumatic lateral C2–3 dislocation without neurological deficits: unique case and its management. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:213-217. [DOI: 10.1007/s00586-017-5039-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/20/2017] [Accepted: 03/09/2017] [Indexed: 10/19/2022]
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Khezri N, Ailon T, Kwon BK. Treatment of Facet Injuries in the Cervical Spine. Neurosurg Clin N Am 2017; 28:125-137. [DOI: 10.1016/j.nec.2016.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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43
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Shank CD, Walters BC, Hadley MN. Management of acute traumatic spinal cord injuries. HANDBOOK OF CLINICAL NEUROLOGY 2017; 140:275-298. [PMID: 28187803 DOI: 10.1016/b978-0-444-63600-3.00015-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Acute traumatic spinal cord injury (SCI) is a devastating disease process affecting tens of thousands of people across the USA each year. Despite the increase in primary prevention measures, such as educational programs, motor vehicle speed limits, automobile running lights, and safety technology that includes automobile passive restraint systems and airbags, SCIs continue to carry substantial permanent morbidity and mortality. Medical measures implemented following the initial injury are designed to limit secondary insult to the spinal cord and to stabilize the spinal column in an attempt to decrease devastating sequelae. This chapter is an overview of the contemporary management of an acute traumatic SCI patient from the time of injury through the stay in the intensive care unit. We discuss initial triage, immobilization, and transportation of the patient by emergency medical services personnel to a definitive treatment facility. Upon arrival at the emergency department, we review initial trauma protocols and the evidence-based recommendations for radiographic evaluation of the patient's vertebral column. Finally, we outline closed cervical spine reduction and various aggressive medical therapies aimed at improving neurologic outcome.
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Affiliation(s)
- C D Shank
- Department of Neurosurgery, University of Alabama, Birmingham, AL, USA
| | - B C Walters
- Department of Neurosurgery, University of Alabama, Birmingham, AL, USA
| | - M N Hadley
- Department of Neurosurgery, University of Alabama, Birmingham, AL, USA.
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44
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Finnegan J, Ye H. Cell therapy for spinal cord injury informed by electromagnetic waves. Regen Med 2016; 11:675-91. [DOI: 10.2217/rme-2016-0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Spinal cord injury devastates the CNS, besetting patients with symptoms including but not limited to: paralysis, autonomic nervous dysfunction, pain disorders and depression. Despite the identification of several molecular and genetic factors, a reliable regenerative therapy has yet to be produced for this terminal disease. Perhaps the missing piece of this puzzle will be discovered within endogenous electrotactic cellular behaviors. Neurons and stem cells both show mediated responses (growth rate, migration, differentiation) to electromagnetic waves, including direct current electric fields. This review analyzes the pathophysiology of spinal cord injury, the rationale for regenerative cell therapy and the evidence for directing cell therapy via electromagnetic waves shown by in vitro experiments.
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Affiliation(s)
- Jack Finnegan
- Department of Biology, Loyola University Chicago, 1032 W. Sheridan Rd, Chicago, IL 60660, USA
| | - Hui Ye
- Department of Biology, Loyola University Chicago, 1032 W. Sheridan Rd, Chicago, IL 60660, USA
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45
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Ducis K, Florman JE, Rughani AI. Appraisal of the Quality of Neurosurgery Clinical Practice Guidelines. World Neurosurg 2016; 90:322-339. [PMID: 26947727 DOI: 10.1016/j.wneu.2016.02.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/09/2016] [Accepted: 02/11/2016] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The rate of neurosurgery guidelines publications was compared over time with all other specialties. Neurosurgical guidelines and quality of supporting evidence were then analyzed and compared by subspecialty. METHODS The authors first performed a PubMed search for "Neurosurgery" and "Guidelines." This was then compared against searches performed for each specialty of the American Board of Medical Specialties. The second analysis was an inventory of all neurosurgery guidelines published by the Agency for Healthcare Research and Quality Guidelines clearinghouse. All Class I evidence and Level 1 recommendations were compared for different subspecialty topics. RESULTS When examined from 1970-2010, the rate of increase in publication of neurosurgery guidelines was about one third of all specialties combined (P < 0.0001). However, when only looking at the past 5 years the publication rate of neurosurgery guidelines has converged upon that for all specialties. The second analysis identified 49 published guidelines for assessment. There were 2733 studies cited as supporting evidence, with only 243 of these papers considered the highest class of evidence (8.9%). These papers were used to generate 697 recommendations, of which 170 (24.4%) were considered "Level 1" recommendations. CONCLUSION Although initially lagging, the publication of neurosurgical guidelines has recently increased at a rate comparable with that of other specialties. However, the quality of the evidence cited consists of a relatively low number of high-quality studies from which guidelines are created. Wider implications of this must be considered when defining and measuring quality of clinical performance in neurosurgery.
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Affiliation(s)
- Katrina Ducis
- Division of Neurosurgery, Department of Surgery, University of Vermont, Burlington, Vermont, USA.
| | - Jeffrey E Florman
- Neuroscience Institute, Maine Medical Center, Portland, Maine, USA; Department of Neurosurgery, Tufts University Medical Center, Boston, Massachusetts, USA
| | - Anand I Rughani
- Neuroscience Institute, Maine Medical Center, Portland, Maine, USA; Department of Neurosurgery, Tufts University Medical Center, Boston, Massachusetts, USA; Center for Excellence in Neuroscience, University of New England, Biddeford, Maine, USA
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Yang Y, Ma L, Li T, Liu H. Redislocation After a Failed Surgery to Treat C6/7 Fracture-Dislocation With Pedicular Fracture of the C6 Vertebra: Case Report of a Successful Revision Surgery, Analysis of the Causes, and Discussion of Revision Surgical Strategies. Medicine (Baltimore) 2016; 95:e3123. [PMID: 26962843 PMCID: PMC4998924 DOI: 10.1097/md.0000000000003123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Cervical spinal fracture-dislocation with pedicular fracture of the vertebra has been little reported and the management of such a patient is difficult. Considering the little knowledge of this area, we present this special case of a successful revision surgery for the treatment of redislocation after a failed surgery to treat C6/7 fracture-dislocation with pedicular fracture of the C6 vertebra to share our experience.A 45-year-old male patient presented to our hospital with history of neck pain for 4 months. According to his medical records, he was involved in an architectural accident and diagnosed with C6/7 fracture-dislocation with pedicular fracture of the C6 vertebra (ASIA: D). A surgery of posterior lateral mass screw fixation (bilateral in C5 and C7; left side in C6) was performed in a different institution. However, 4 months after his primary surgery, he was still troubled by serious neck pain and muscle weakness in all right side limbs. The physical examination of the patient showed hypoesthesia in the right side limbs, myodynamia of the right side limbs weakened to Grade 4. Cervical X-rays, computed tomography (CT), and magnetic resonance imaging confirmed the redislocation of C6/7. A successful revision surgery of anterior cervical corpectomy and fusion (ACCF) with nanohydroxyapatite/polyamide 66 composite fulfilled with vertebral autograft plus anterior plate was performed. The 3 months postoperative X-rays and CT scan showed the good position of the implant and bony fusion. The patient's neck pain was relived and the neurological function recovered to ASIA E grade at the 3rd month follow-up.ACCF with nanohydroxyapatite/polyamide 66 composite fulfilled with vertebral autograft plus anterior plate is effective for the treatment of redislocation after a failed surgery in patients of fracture-dislocation with pedicular fracture. The best method to avoid such a failed surgery is a combined anterior-posterior approach surgery in our opinion.
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Affiliation(s)
- Yi Yang
- From the Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China
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47
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Padwal A, Shukla D, Bhat DI, Somanna S, Devi BI. Post-traumatic cervical spondyloptosis: A rare entity with multiple management options. J Clin Neurosci 2016; 28:61-6. [PMID: 26922508 DOI: 10.1016/j.jocn.2015.05.074] [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] [Received: 02/04/2015] [Accepted: 05/31/2015] [Indexed: 11/30/2022]
Abstract
Post-traumatic cervical spondyloptosis is a rare condition associated with high energy injuries, and to our knowledge only case reports are available. There are no universally accepted treatment paradigms for these cases and management is individualised according to the case and surgeon preference. We retrospectively analysed our management and clinical outcomes of this condition. From January 2007 to August 2014 we treated eight patients with cervical spondyloptosis at our institute. Only two patients had no neurological deficits; all the remaining patients had partial cord injury. Seven were treated surgically with preoperative traction followed by anterior cervical discectomy and fusion with fixation in three patients, and combined anterior and posterior fusion and fixation in four. Depending on the presence of anterior compression by a disc an anterior first or posterior first approach was advocated. All four combined anterior and posterior fusion and fixation patients needed to be turned more than once (540°). There was no neurological deterioration in any of the patients, as they either improved or remained stable neurologically. Post-traumatic cervical spondyloptosis is a challenging entity to manage. Surgery can be done safely with good clinical and radiological outcome and needs to be tailored to the individual patient.
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Affiliation(s)
- A Padwal
- Department of Neurosurgery, NIMHANS, Hosur Road/Marigowda Road, Bangalore 560029, India
| | - D Shukla
- Department of Neurosurgery, NIMHANS, Hosur Road/Marigowda Road, Bangalore 560029, India
| | - D I Bhat
- Department of Neurosurgery, NIMHANS, Hosur Road/Marigowda Road, Bangalore 560029, India.
| | - S Somanna
- Department of Neurosurgery, NIMHANS, Hosur Road/Marigowda Road, Bangalore 560029, India
| | - B I Devi
- Department of Neurosurgery, NIMHANS, Hosur Road/Marigowda Road, Bangalore 560029, India
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Park JH, Roh SW, Rhim SC. A single-stage posterior approach with open reduction and pedicle screw fixation in subaxial cervical facet dislocations. J Neurosurg Spine 2015; 23:35-41. [PMID: 25909272 DOI: 10.3171/2014.11.spine14805] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
The optimal treatment for cervical facet dislocations is controversial, but the generally accepted process recommends an initial closed reduction with the next step determined according to the success of the closed reduction and the presence of traumatic disc herniation. This study aimed to show the efficacy of a posterior approach performed with an open reduction and pedicle screw fixation with removal of disc particles, if required, in the management of subaxial cervical dislocations.
METHODS
Between March 2012 and September 2013, 21 consecutive patients with cervical facet dislocations were enrolled. The affected levels were as follows: 4 at C3–4; 2 at C4–5; 5 at C5–6; and 10 at the C6–7 level. Seven patients had traumatic disc herniations. Closed reduction was not attempted; a prompt posterior cervical surgery was performed instead. After open reduction, pedicle screw fixation was performed. In cases with traumatic disc herniation, herniated disc fragments were excised via a posterolateral approach and successful decompressions were determined by postoperative MRI studies. Clinical outcomes were assessed using the American Spinal Injury Association (ASIA) grading system. Radiological outcomes were assessed by comparing the degree of subluxation and the angle of segmental lordosis between pre- and postoperative CT scans.
RESULTS
All patients improved neurologically. The mean segmental angles improved from 7.3° ± 8.68° to −5.9° ± 4.85°. The mean subluxation improved from 23.4% ± 16.52% to 2.6% ± 7.19%. Disc fragments were successfully removed from the 7 patients with herniated discs, as shown on MRI.
CONCLUSIONS
Open reduction followed by pedicle screw fixation or posterolateral removal of herniated disc fragments is a good treatment option for cervical facet dislocations.
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Affiliation(s)
- Jin Hoon Park
- 1Department of Neurological Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea; and
| | - Sung Woo Roh
- 2Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Chul Rhim
- 2Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Immediate reduction under general anesthesia and single-staged anteroposterior spinal reconstruction for fracture-dislocation of lower cervical spine. ACTA ACUST UNITED AC 2015; 28:E1-8. [PMID: 24335725 DOI: 10.1097/bsd.0000000000000065] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Fracture-dislocation of the lower cervical spine is a severe traumatic lesion, most frequently resulting in tetraplegia. Treatment is usually painful and time consuming. This retrospective study evaluated the clinical curative effect of immediate reduction under general anesthesia and single-staged anteroposterior spinal reconstruction for fracture-dislocation of the lower cervical spine. Twelve cases of traumatic lower cervical spinal fracture-dislocation were retrospectively analyzed from January 2006 to December 2011. The injury level was C4/C5 in 4, C5/C6 in 5, and C6/C7 in 3 patients. The spinal cord function grades according to the American Spinal Injury Association impairment scale (2000 edition amended) before operation were as follows: grade A in 2 cases, grade B in 2 cases, grade C in 5 cases, grade D in 2 cases, and grade E in 1 case. On admission, all patients underwent immediate reduction under general anesthesia and single-staged anteroposterior spinal reconstruction by circumferential fixation/fusion. The spinal cord function grades according to American Spinal Injury Association after operation were as follows: grade A in 1 case, grade B in 1 case, grade C in 3 cases, grade D in 3 cases, and grade E in 4 cases. All 12 patients showed evidence of stability at the instrumented level on the final follow-up examination (mean follow-up, 3.7 y). Immediate reduction under general anesthesia followed by a single-stage combined anteroposterior spinal reconstruction is a safe and reliable way of treating patients with lower cervical spine fracture-dislocations.
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Bodman A, Chin L. Bony fusion in a chronic cervical bilateral facet dislocation. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:104-8. [PMID: 25702178 PMCID: PMC4338806 DOI: 10.12659/ajcr.892173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 09/18/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cervical facet dislocation injuries typically present shortly after occurrence due to the pain and neurologic deficit that can be associated with this injury. Bilateral dislocations of the facet joint require prompt evaluation, reduction, and surgical intervention. Rare case reports present bilateral dislocations presenting in a delayed fashion. CASE REPORT We report the case of a 60-year-old male who presented with mild neck pain 1 year after initial injury. Computed topography of the cervical spine showed healing with bony fusion of a bilateral C6-7 facet dislocation. Given the chronic healed nature of the injury and minimal symptoms, the patient is being followed without intervention. CONCLUSIONS Although most bilateral facet dislocations present and are treated immediately after injury; this case illustrates that some may be missed during initial evaluation. Once healed, these injuries may be stable without surgical intervention.
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