scholarly journals The Effect of Surgical Intervention for Delayed Cervical Central Cord Syndrome

2017 ◽  
Vol 2017 ◽  
pp. 1-5
Author(s):  
Yanan Liu ◽  
Zongyi Wang ◽  
Shaofeng Yang ◽  
Huilin Yang ◽  
Jun Zou
Keyword(s):  
Surgical Intervention ◽  
Spinal Injury ◽  
American Spinal Injury Association ◽  
Japanese Orthopedic Association ◽  
Sf 36 ◽  
Cord Injury ◽  
Central Cord Syndrome ◽  
Time Point ◽  
The Ideal

The authors retrospectively studied 11 patients with delayed cervical central cord syndrome (CCS) to investigate the efficacy of the surgical intervention on treatment for delayed CCS. The American Spinal Injury Association (ASIA) motor scores, Japanese Orthopedic Association (JOA) scores, SF-36 scores, and neurologic status were analyzed preoperatively and at each time point of postoperative follow-up. The results show that patients with reversible spinal cord injury caused by delayed central cord syndrome can recover significantly after surgical intervention. Therefore, we suggest that surgical intervention is still the ideal choice for delayed cervical central cord syndrome.

Effectiveness of surgical treatment for traumatic central cord syndrome

2009 ◽  
Vol 10 (1) ◽  
pp. 3-8 ◽  
Author(s):  
Liang Chen ◽  
Huilin Yang ◽  
Tongqi Yang ◽  
Yaozeng Xu ◽  
Zhaohua Bao ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Surgical Intervention ◽  
Motor Score ◽  
Score Improvement ◽  
Sf 36 ◽  
Significant Difference ◽  
Cord Injury ◽  
Central Cord Syndrome ◽  
Asia Score

Object The authors undertook a study in patients with traumatic central cord syndrome (TCCS) who underwent surgical intervention. They retrospectively assessed the motor score improvement and functional status and identified prognostic predictors of improvement. Methods Between March 1999 and May 2004, 49 patients with TCCS were surgically treated. Motor scores were collected at admission and follow-up using the American Spinal Injury Association (ASIA) Impairment Scale. The 36-Item Short Form Health Survey (SF-36) was administered. Other parameters including walking index, spasticity, bladder management, and neuropathic pain scores were recorded. Patients were asked to assess their level of satisfaction with their final symptoms. Results The average ASIA score, converted into numeric values, was increased from 54.9 at admission to 81.9 and 89.6 at 6 months and final follow-up, respectively. Significant improvement of ASIA score was achieved within the first 6 months of surgery. No significant difference was found between patients who underwent surgery within 4 days of injury or after 4 days of injury, adopting different approaches (anterior, posterior, or a combination), or with different pathological entities (acute disc herniation, fracture or dislocation, or multilevel degeneration). The ASIA score improvement had a positive correlation with the age at injury (r = 0.505, p = 0.023). The SF-36 data at 6 months and final follow-up were not as satisfactory as the improvement in ASIA scores, and almost one-third of patients expressed dissatisfaction with their final symptoms. For patients who were older than 65 years at injury, the mean follow-up Walking Index for Spinal Cord Injury (WISCI) score was statistically lower than it was in younger patients. The presence of spasticity or neuropathic pain at follow-up was not related to age, sex, ASIA motor score, or WISCI outcome. Conclusions Surgical intervention can be safely applied in patients with TCCS. Significant improvement of ASIA score was achieved during the first 6-month period of follow-up. Factors including type of lesion, timing of surgery within or after 4 days of injury, and surgical approach were not significantly associated with final ASIA score. The improvement in the ASIA motor score was positively correlated with age at injury. No significant correlation was found between or among the presence of spasticity, neuropathic pain, and ASIA score at final visit. Almost one-third of patients were not satisfied with their final symptoms.

Long-Term Follow-up of Patients with Spinal Cord Injury

2005 ◽  
Vol 19 (4) ◽  
pp. 332-337 ◽  
Author(s):  
Figen Yilmaz ◽  
Fusun Sahin ◽  
Semra Aktug ◽  
Banu Kuran ◽  
Adem Yilmaz
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Injury ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
American Spinal Injury Association ◽  
Cord Injury ◽  
Long Term Follow Up

Objective. The aim of this study was to evaluate the motor, sensory, and functional recovery in patients with spinal cord injury (SCI). Methods. Forty-one patients with SCI participated in this study. Twenty patients were evaluated after discharge. Each patient was evaluated by the American Spinal Injury Association (ASIA) impairment scale and the Functional Independence Measure (FIM) at admission, before discharge, and at least at 6 months after discharge. Friedman, Dunn, and Mann-Whitney U tests were used for statistical analysis. Results. There were 17 male and 3 female patients. Seven patients had complete SCI, and 13 patients had incomplete SCI. The evaluation of motor, sensory, and FIM scores at admission showed significant improvement in all of the patients during the follow-up period (P < 0.0001). Five incompletely injured cases improved with regard to ASIA staging. Motor and FIM scores significantly increased at follow-up for converted and unconverted patients. All parameters increased at follow-up in patients who were complete and incomplete. Motor scores significantly increased at discharge and at follow-up. FIM scores also increased significantly at follow-up in incomplete patients. Conclusion. Motor, sensory, and FIM scores increased in patients with SCI after a follow-up period of 18 months. Improvement to a higher ASIA stage could be accomplished by 25% of the patients. Although both complete and incomplete patients recovered significantly at the follow-up period, only incompletely injured cases could convert to a higher ASIA stage.

scholarly journals Correlation of magnetic resonance diffusion tensor imaging parameters with American Spinal Injury Association score for prognostication and long-term outcomes

2019 ◽  
Vol 46 (3) ◽  
pp. E2 ◽  
Author(s):  
Saman Shabani ◽  
Mayank Kaushal ◽  
Matthew Budde ◽  
Shekar N. Kurpad
Keyword(s):  
Correlation Analysis ◽  
Spinal Injury ◽  
Time Of Arrival ◽  
American Spinal Injury Association ◽  
Long Term Outcome ◽  
Imaging Parameters ◽  
Cord Injury ◽  
Asia Score

OBJECTIVEConventional MRI is routinely used to demonstrate the anatomical site of spinal cord injury (SCI). However, quantitative and qualitative imaging parameters have limited use in predicting neurological outcomes. Currently, there are no reliable neuroimaging biomarkers to predict short- and long-term outcome after SCI.METHODSA prospective cohort of 23 patients with SCI (19 with cervical SCI [CSCI] and 4 with thoracic SCI [TSCI]) treated between 2007 and 2014 was included in the study. The American Spinal Injury Association (ASIA) score was determined at the time of arrival and at 1-year follow-up. Only 15 patients (12 with CSCI and 3 with TSCI) had 1-year follow-up. Whole-cord fractional anisotropy (FA) was determined at C1–2, following which C1–2 was divided into upper, middle, and lower segments and the corresponding FA value at each of these segments was calculated. Correlation analysis was performed between FA and ASIA score at time of arrival and 1-year follow-up.RESULTSCorrelation analysis showed a positive but nonsignificant correlation (p = 0.095) between FA and ASIA score for all patients (CSCI and TCSI) at the time of arrival. Additional regression analysis consisting of only patients with CSCI showed a significant correlation (p = 0.008) between FA and ASIA score at time of arrival as well as at 1-year follow-up (p = 0.025). Furthermore, in case of patients with CSCI, a significant correlation between FA value at each of the segments (upper, middle, and lower) of C1–2 and ASIA score at time of arrival was found (p = 0.017, p = 0.015, and p = 0.002, respectively).CONCLUSIONSIn patients with CSCI, the measurement of diffusion anisotropy of the high cervical cord (C1–2) correlates significantly with injury severity and long-term follow-up. However, this correlation is not seen in patients with TSCI. Therefore, FA can be used as an imaging biomarker for evaluating neural injury and monitoring recovery in patients with CSCI.

scholarly journals Olfactory ensheathing cell transplantation for chronic spinal cord injury: A long-term follow-up study

2021 ◽  
Vol 9 (2) ◽  
pp. 94-105
Author(s):  
Naifeng Kuang ◽  
Xiaoyu Wang ◽  
Yuexia Chen ◽  
Guifeng Liu ◽  
Fan’e Kong ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Autonomic Function ◽  
Spinal Injury ◽  
International Standards ◽  
Olfactory Ensheathing Cell ◽  
Cord Injury ◽  
Long Term Follow Up

Spinal cord injury is a serious disabling condition. Transplantation of olfactory ensheathing cells (OECs) is one of the most promising treatments for spinal cord injury (SCI). Thirty-nine patients with chronic SCI received OEC transplantation and completed long-term follow-up, with a minimum follow-up of 7 years. We assessed sensorimotor function with the American Spinal Injury Association (ASIA) Impairment Scale (AIS) and autonomic nervous function by the International Standards to document remaining Autonomic Function after Spinal Cord Injury (ISAFSCI), and sympathetic skin responses (SSR). The scores of each group were significantly higher after OECs transplantation than before treatment. SSR latencies were shorter and response amplitudes increased after treatment. Long-term follow-up showed further improvement only in motor function and autonomic function compared with 3 months postoperatively. No complications occurred in any patient during long-term follow-up. The results indicate that the transplantation of OECs in spinal cord restored function without serious side effects.

scholarly journals Development of a Clinical Prediction Model for Central Cord Syndrome: An Evaluation of Motor Recovery and the Effectiveness of Early Surgery

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Jetan H Badhiwala ◽  
Christopher D Witiw ◽  
Jefferson R Wilson ◽  
Michael G Fehlings
Keyword(s):  
Prediction Model ◽  
Spinal Injury ◽  
A Priori ◽  
Motor Recovery ◽  
Early Surgery ◽  
Clinical Prediction ◽  
Clinical Prediction Model ◽  
Time To Surgery ◽  
Cord Injury ◽  
Central Cord Syndrome

Abstract INTRODUCTION There remains a paucity of data on the outcomes of central cord syndrome (CCS) and their predictors in the modern era. Further, the efficacy of early surgical decompression, within 24 hr, for CCS remains unclear. In patients with CCS, we therefore sought to: 1) develop a clinical prediction model for neurological outcome; and 2) evaluate the effect of early surgery (<24 hr) on neurological recovery. METHODS Patients with CCS (AIS grade C or D; LEMS UEMS ≥5) were identified from two prospective, multi-center spinal cord injury (SCI) datasets (NACTN; STASCIS). A clinical prediction model was developed by multiple linear regression; the outcome was change in American Spinal Injury Association (ASIA) motor score (AMS) at 1-yr. Covariates were chosen a priori: age, baseline AMS, baseline AIS grade, time to surgery (early [<24 hr] vs late [≥24 hr]), and time to surgery AIS grade. Effect sizes were summarized by ß coefficients. Internal validation was performed by bootstrapping. The model was externally validated in a cohort of patients from the NASCIS III trial. RESULTS A total of 211 patients were eligible. ß coefficients were significant for all variables in the model: age (−0.12, P = .04); baseline AMS (−0.71, P < .01); AIS grade (9.69, P = .01); time to surgery (12.67, P < .01); AIS grade × time to surgery (−13.18, P < .01). The mean R2 value across bootstraps was 0.66. In patients with AIS C injury, early surgery resulted in significantly improved motor recovery (marginal mean: +12.7, 95% CI 5.8-19.6); there was no difference in recovery with early surgery in patients with AIS D injury (marginal mean: −0.5, 95% CI −4.4-3.3). The model showed good external validity (R2 = 0.65 in validation cohort, N = 38). CONCLUSION Motor recovery after CCS may be predicted by age, AMS, AIS grade, and time to surgery. Early surgery improves recovery, particularly in patients with more severe injury.

Neurological prognosis after traumatic quadriplegia

1979 ◽  
Vol 50 (5) ◽  
pp. 611-616 ◽  
Author(s):  
Frederick M. Maynard ◽  
Glenn G. Reynolds ◽  
Steven Fountain ◽  
Conal Wilmot ◽  
Richard Hamilton
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Injury ◽  
Head Injuries ◽  
Gunshot Wounds ◽  
Neurological Impairment ◽  
Treatment Protocols ◽  
Content Type ◽  
Cord Injury

✓ Between January, 1974, and December, 1976, 123 patients with traumatic quadriplegia were admitted to the California Regional Spinal Cord Injury Care System. The spinal cord injury resulted from gunshot wounds in five, from a stab wound in one, from neck injuries with no bone damage seen on x-ray studies in 10, and from fracture dislocations of the cervical spine in 107. One-year follow-up information was available on 114 patients. Neurological impairment using the Frankel classification system was compared at 72 hours postinjury to the 1-year follow-up examination. Fifty of 62 patients with complete injury at 72 hours were unchanged at 1 year. Five of these 62 patients had developed motor useful function in the legs or became ambulatory by 1 year, but all had sustained serious head injuries at the time of their trauma making initial neurological assessment unreliable. Ten percent of all cases had combined head injury impairing consciousness. Among 103 cognitively intact patients, none with complete injury at 72 hours were walking at 1 year. Of patients with sensory incomplete function at 72 hours postinjury, 47% were walking at 1 year; 87% of patients with motor incomplete function at 72 hours postinjury were walking at 1 year. Spinal surgery during the first 4 weeks postinjury did not improve neurological recovery. A method of analyzing neurological and functional outcomes of spinal cord injury is presented in order to more accurately evaluate the results of future treatment protocols for acute spinal injury.

Failure of Mean Arterial Pressure Goals to Improve Outcomes Following Penetrating Spinal Cord Injury

Neurosurgery ◽  
2016 ◽  
Vol 79 (5) ◽  
pp. 708-714 ◽  
Author(s):  
William J. Readdy ◽  
Rajiv Saigal ◽  
William D. Whetstone ◽  
Anthony N. Mefford ◽  
Adam R. Ferguson ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Patient Population ◽  
Spinal Injury ◽  
Neurological Recovery ◽  
American Spinal Injury Association ◽  
Neurological Improvement ◽  
Cord Injury

Abstract BACKGROUND: Increased spinal cord perfusion and blood pressure goals have been recommended for spinal cord injury (SCI). Penetrating SCI is associated with poor prognosis, but there is a paucity of literature examining the role of vasopressor administration for the maintenance of mean arterial pressure (MAP) goals in this patient population. OBJECTIVE: To elucidate this topic and to determine the efficacy of vasopressor administration in penetrating SCI by examining a case series of consecutive penetrating SCIs. METHODS: We reviewed consecutive patients with complete penetrating SCI who met inclusion and exclusion criteria, including the administration of vasopressors to maintain MAP goals. We identified 14 patients with complete penetrating SCIs with an admission American Spinal Injury Association grade of A from 2005 to 2011. The neurological recovery, complications, interventions, and vasopressor administration strategies were reviewed and compared with those of a cohort with complete blunt SCI. RESULTS: In our patient population, only 1 patient with penetrating SCI (7.1%) experienced neurological recovery, as determined by improvement in the American Spinal Injury Association grade, despite the administration of vasopressors for supraphysiological MAP goals for an average of 101.07 ± 34.96 hours. Furthermore, 71.43% of patients with penetrating SCI treated with vasopressors experienced associated cardiogenic complications. CONCLUSION: Given the decreased likelihood of neurological improvement in penetrating injuries, it may be important to re-examine intervention strategies in this population. Specifically, the use of vasopressors, in particular dopamine, with their associated complications is more likely to cause complications than to result in neurological improvement. Our experience shows that patients with acute penetrating SCI are unlikely to recover, despite aggressive cardiopulmonary management.

scholarly journals The Use of Electrical Stimulation and Taping to Address Shoulder Subluxation for a Patient With Central Cord Syndrome

2004 ◽  
Vol 84 (7) ◽  
pp. 634-643 ◽  
Author(s):  
Colleen Peterson
Keyword(s):  
Electrical Stimulation ◽  
Case Report ◽  
Upper Extremity ◽  
Spinal Injury ◽  
American Spinal Injury Association ◽  
Case Description ◽  
Central Cord Syndrome ◽  
Stroke Case ◽  
The Right ◽  
Acute Rehabilitation

Background and Purpose. This case report describes the examination, intervention, and outcome of a patient with central cord syndrome (CCS) who participated in acute rehabilitation that included the use of electrical stimulation (ES) and strapping to address shoulder subluxation. The only literature found describing these interventions for shoulder subluxation was for patients with stroke. Case Description. The patient was a 29-year-old man with CCS and bilateral shoulder subluxation. He received ES over 8 weeks to the anterior and middle deltoid and supraspinatus muscles of the right shoulder. Taping was repeated every 3 to 4 days on both shoulders following over the anterior and middle deltoid muscles up to the acromion. Outcomes. The initial shoulder subluxation measurements were 1.5 cm on the right and 1.0 cm on the left. The final measurements were 0.3 cm on the right and 0.2 cm on the left. The patient's American Spinal Injury Association upper-extremity motor scores were 26/50 initially and 48/50 at discharge. Conclusion. The use of ES and shoulder taping in conjunction with other rehabilitation may have played a role in reducing the patient's shoulder subluxation.

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