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Autonomic dysreflexia in patients with cancer and spinal cord injury: a case series. 癌症和脊髓损伤患者的自主神经反射障碍:病例系列。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2024-09-04 DOI: 10.1038/s41394-024-00678-7
Evelyn Qin, Genevieve M Marshall, Lisa Ruppert

Introduction: Autonomic dysreflexia (AD) is a potentially life-threatening syndrome that can occur in patients with traumatic injury to the spinal cord; however, it has not been well described in patients with non-traumatic spinal cord injury (SCI) from cancer and its treatments.

Case presentation: We report four cases of autonomic dysreflexia secondary to primary spinal cord tumors and metastatic disease to the spine, and as sequela to cancer treatment. The clinical characteristics, diagnostic considerations, and therapeutic strategies used to mitigate the symptoms are discussed.

Discussion: The case series shows that AD is a rare but important condition to consider among patients with cancer-related SCI. There is a need for close monitoring and early identification of this syndrome in this population. Therapeutic strategies are available to mitigate these symptoms and risks of complications.

导言:自律神经反射障碍(AD)是一种可能危及生命的综合征,可发生在脊髓外伤患者身上;然而,对于癌症及其治疗导致的非外伤性脊髓损伤(SCI)患者,还没有很好的描述:我们报告了四例继发于原发性脊髓肿瘤和脊柱转移性疾病以及癌症治疗后遗症的自主神经反射障碍病例。讨论:本系列病例表明,在癌症相关 SCI 患者中,AD 是一种罕见但需要考虑的重要病症。有必要对这一人群进行密切监测并及早发现这一综合征。治疗策略可减轻这些症状和并发症的风险。
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引用次数: 0
A patient with cervical ligamentum flavum haematoma: case report. 一名颈部黄韧带血肿患者:病例报告。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2024-08-29 DOI: 10.1038/s41394-024-00679-6
Nixi Xu, Chang Jiang, Zixian Chen, Zhenzhou Feng, Chun Jiang, Yuanwu Cao

Introduction: Ligamentum flavum haematoma (LFH) is an extremely rare entity, found mostly in the lumbar and thoracic ligamentum flavum and seldom in the cervical ligamentum flavum. Cervical LFH can cause paralysis in patients. We describe a case of LFH in the cervical spine that accepted surgical treatment.

Case presentation: A 70-year-old man with incomplete spinal cord injury presented with sudden paralysis of his left limbs for 10 days and hemi-hypaesthesia below the level of the right clavicle. Magnetic resonance imaging (MRI) showed a space-occupying lesion in the left ligamentum flavum between the C4 and C5 laminae. The preliminary diagnoses were concluded to be incomplete spinal cord injury, spinal epidural lesions, and cervical spinal stenosis. After a posterior C3-C6 laminectomy with lateral mass screw instrumentation, the muscle strength and sensation recovered partially. The lesion was greyish black and located in the ligamentum flavum. A pathological examination identified it as a haematoma of the ligamentum flavum. The patient was discharged 15 days after the operation and commenced rehabilitation.

Discussion: The LFH was mainly caused by slight trauma during gentle activities and contributed by many factors. MRI is an essential tool but pathological diagnosis is the gold standard. Most LFH patients can be treated surgically.

简介黄韧带血肿(LFH)是一种极为罕见的疾病,主要发生在腰部和胸部黄韧带,很少发生在颈部黄韧带。颈椎黄韧带瘤可导致患者瘫痪。我们描述了一例接受手术治疗的颈椎LFH病例:一名患有不完全脊髓损伤的 70 岁男子突然左侧肢体瘫痪 10 天,右锁骨水平以下半身麻痹。磁共振成像(MRI)显示,C4 和 C5 椎板之间的左侧黄韧带有占位性病变。初步诊断为不完全脊髓损伤、脊髓硬膜外病变和颈椎管狭窄。在进行了 C3-C6 后椎板切除术和侧方肿块螺钉器械植入术后,患者的肌力和感觉得到了部分恢复。病变呈灰黑色,位于黄韧带。病理检查确定为黄韧带血肿。术后 15 天,患者康复出院:讨论:黄韧带血肿主要是在轻微活动时受到轻微外伤所致,其形成因素很多。磁共振成像是一种重要工具,但病理诊断才是金标准。大多数 LFH 患者可通过手术治疗。
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引用次数: 0
Solitary thoracic spine osteochondroma: a rare cause for spinal cord compression. 孤立性胸椎骨软骨瘤:脊髓压迫的罕见病因。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2024-08-22 DOI: 10.1038/s41394-024-00677-8
Ghassen Gader, Mohamed Amine Gharbi, Mohamed Ali Kharrat, Ahmed Harbaoui, Ihsèn Zammel

Introduction: Osteochondromas, also known as osteocartilaginous exostosis, are among the most common benign cartilaginous bone tumors, primarily occurring as solitary lesions. While typically found in long bones, spinal involvement is rare, accounting for only a small percentage of benign lesions in this location. Solitary osteochondromas responsible for spinal cord compression are seldom.

Case presentation: We describe the case of a 34-year-old male with no significant medical history, presenting with progressive symptoms suggestive of spinal cord compression. Imaging studies revealed a bony lesion originating from the left lateral aspect of the posterior arch of the T8 vertebra, causing spinal cord compression and myelopathy. Surgical intervention was necessary to decompress the spinal cord and obtain histological samples, resulting in immediate postoperative improvement in motor function. Pathologic exam concluded to an osteochondroma.

Discussion: Osteochondromas primarily affect growing bones and are more commonly observed as solitary lesions, particularly in male patients. Spinal involvement is rare, and neurological symptoms are typically indicative of intracanalar extension of the exostosis, leading to compression of neural elements. Imaging modalities such as MRI are crucial for assessing cartilage thickness and the impact of compression on the spinal cord.

简介:骨软骨瘤又称骨软骨外生瘤,是最常见的良性软骨肿瘤之一:骨软骨瘤又称骨软骨外生瘤,是最常见的良性软骨肿瘤之一,主要为单发性病变。虽然通常发生在长骨中,但脊柱受累的情况很少见,只占该部位良性病变的一小部分。导致脊髓受压的单发骨软骨瘤很少见:我们描述了一例 34 岁男性的病例,患者无明显病史,出现进行性症状,提示脊髓受压。影像学检查显示,T8椎体后弓左外侧有一骨质病变,导致脊髓受压和脊髓病变。必须进行手术治疗,为脊髓减压并获取组织学样本,术后患者的运动功能立即得到改善。病理检查结果为骨软骨瘤:讨论:骨软骨瘤主要影响生长中的骨骼,多为单发,尤其是男性患者。脊柱受累的情况很少见,神经症状通常是外骨瘤在椎管内扩展,导致神经元受压。核磁共振成像等成像方式对于评估软骨厚度和压迫对脊髓的影响至关重要。
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引用次数: 0
Effectiveness of virtual-walking intervention combined with exercise on improving pain and function in incomplete spinal cord injury: a feasibility study. 虚拟行走干预结合运动对改善不完全脊髓损伤患者疼痛和功能的效果:一项可行性研究。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2024-08-22 DOI: 10.1038/s41394-024-00675-w
Sara Mollà-Casanova, Elena Muñoz-Gómez, Marta Aguilar-Rodríguez, Marta Inglés, Núria Sempere-Rubio, Noemí Moreno-Segura, Pilar Serra-Añó

Study design: A feasibility pilot study.

Objective: To assess the feasibility a full-scale Randomized Controlled Trial aimed at assessing the beneficial effect of a Virtual Walking (VW)-based (Experimental intervention (EI)) on neuropathic pain and functionality in people with incomplete spinal cord injury (SCI).

Setting: A hospital service (Hospital Universitario y Politécnico La Fe) and disability associations (TetraSport, CODIFIVA and ASPAYM).

Methods: Twelve people with chronic incomplete SCI were randomized to EI (VW plus therapeutic exercise program (TE)) -or Control Intervention (CI (placebo VW and TE)) groups. A six-week intervention (3 sessions/week) was carried out. To assess feasibility, the following outcomes were used: level of restriction and validity of inclusion and exclusion criteria, participants' compliance, accessibility and acceptability of the intervention for participants, adequate pre-training time of physiotherapists. To explore therapy effectiveness, pain severity, and interference, mean and maximum isometric strength, walking speed, and walking ability were assessed before (Time 1, T1) and after (Time 2, T2) the intervention.

Results: 20% of the participants initially recruited did not meet inclusion criteria. In addition, all participants completed at least 80% of the intervention sessions and none of the participants dropped out before T2. No serious adverse event was found. Moreover, 91.67% of participants were willing to perform the intervention again and all therapists involved were adequately pre-trained. Finally, our preliminary results suggest that the proposed EI is effective.

Conclusion: A full-scale RCT is feasible and preliminary results suggest that VW with TE could have a beneficial impact on pain and functionality in this population.

研究设计可行性试点研究:评估全面随机对照试验的可行性,旨在评估基于虚拟行走(VW)的实验干预(EI)对不完全脊髓损伤(SCI)患者的神经性疼痛和功能性的有益影响:环境:医院服务机构(拉斐大学和理工医院)和残疾人协会(TetraSport、CODIFIVA 和 ASPAYM):12 名慢性不完全 SCI 患者被随机分为 EI 组(VW 加治疗性运动计划 (TE))和对照干预组(CI(安慰剂 VW 和 TE))。干预为期六周(每周三次)。为评估可行性,采用了以下结果:纳入和排除标准的限制程度和有效性、参与者的依从性、干预措施对参与者的可及性和可接受性、物理治疗师的充分预培训时间。为了探讨治疗效果、疼痛严重程度和干扰情况,在干预前(时间 1,T1)和干预后(时间 2,T2)对平均和最大等长肌力、行走速度和行走能力进行了评估。此外,所有参与者都完成了至少80%的干预课程,没有人在T2前退出。没有发现严重的不良事件。此外,91.67%的参与者愿意再次进行干预,所有参与的治疗师都经过了充分的前期培训。最后,我们的初步结果表明,建议的 EI 是有效的:全面的 RCT 是可行的,初步结果表明,使用 TE 的 VW 可以对这一人群的疼痛和功能产生有益的影响。
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引用次数: 0
Reviewer Recognition. 评审员表彰。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2024-08-21 DOI: 10.1038/s41394-024-00672-z
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引用次数: 0
Is deformity correction essential in a "Myelopathic Cord"? - A case series. 髓鞘病性脊柱炎 "患者是否必须进行畸形矫正?- 一个病例系列。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2024-08-20 DOI: 10.1038/s41394-024-00676-9
Rajat Mahajan, Ganesh Kumar

Introduction: The incidence of preoperative neurological deficits in pediatric patients with complex deformities ranges from 15% to 23%. Furthermore, the likelihood of a postoperative neurological deficit can be considerably increased to 83.3% in the presence of a preoperative neurological deficit. Hence, the management of pediatric spinal deformities with neurological deficits is a challenge for every spine surgeon. Here, we describe four consecutive cases of pediatric spinal deformity with myelopathic cord, all of which were managed with decompressive surgery and stabilization without any attempts to correct the deformity. All the patients recovered well neurologically, without any progression of deformity.

Case presentation: The authors obtained the informed written consent from the patient and their parents for the print and electronic publication of the case. All four patients had clinical myelopathy with a progressive, worsening neurological deficit. The pathology was in the thoracic region in all the patients. Of the four cases, two were post-tubercular deformities, and two were congenital deformities. The treatment strategy for all patients was circumferential decompression of the spinal cord with posterior pedicle screw instrumentation. Although all patients had significant neurological deficits (Nurick grade 4 or 5) preoperatively, we used intraoperative neuromonitoring to prevent the worsening of the deficit during the procedure. None of the patients experienced intraoperative signal changes. All patients had significant neurological recovery (Nurick grade 0 to 2) and showed no worsening of deformity at their latest follow-up, up to 4 years. All showed good improvement in all domains of the SRS22r questionnaire.

Discussion: It is challenging for spine surgeons to manage complex spinal abnormalities in pediatric patients with myelopathic cords. Even a minimal manipulation of the cord during surgery might result in severe long-term morbidity. The primary objective in managing such patients should be neurological recovery rather than deformity correction-"First do no harm," and if necessary, the deformity can be corrected at a later stage under neuromonitoring.

简介儿科复杂畸形患者术前神经功能缺损的发生率为 15%至 23%。此外,如果术前存在神经功能缺损,术后出现神经功能缺损的可能性会大大增加,达到 83.3%。因此,小儿脊柱畸形伴神经功能缺损的治疗对每一位脊柱外科医生来说都是一项挑战。在此,我们连续描述了四例伴有脊髓病性脊柱畸形的小儿脊柱畸形病例,所有病例均采用减压手术和稳定术进行治疗,未试图矫正畸形。所有患者的神经系统均恢复良好,畸形没有任何进展:作者获得了患者及其父母的知情同意书,并将病例以印刷版和电子版形式发表。四名患者均患有临床脊髓病,神经功能缺损呈进行性恶化。所有患者的病变均位于胸椎部位。在这四例病例中,两例为结核病后畸形,两例为先天性畸形。所有患者的治疗策略都是通过后椎弓根螺钉器械对脊髓进行环绕减压。虽然所有患者术前都有明显的神经功能缺损(Nurick 4级或5级),但我们在术中使用了神经监测仪,以防止缺损在术中恶化。没有一名患者在术中出现信号变化。所有患者的神经功能都得到了明显恢复(Nurick 分级 0 至 2),并且在最近 4 年的随访中畸形没有恶化。所有患者在SRS22r问卷调查的所有方面都有良好的改善:讨论:脊柱外科医生在处理脊髓病索小儿患者的复杂脊柱畸形时面临挑战。即使在手术过程中对脊髓进行最小程度的操作,也可能导致严重的长期发病率。处理这类患者的首要目标应该是神经功能的恢复,而不是畸形矫正--"首先不要伤害",如有必要,可在神经监测的后期阶段矫正畸形。
{"title":"Is deformity correction essential in a \"Myelopathic Cord\"? - A case series.","authors":"Rajat Mahajan, Ganesh Kumar","doi":"10.1038/s41394-024-00676-9","DOIUrl":"10.1038/s41394-024-00676-9","url":null,"abstract":"<p><strong>Introduction: </strong>The incidence of preoperative neurological deficits in pediatric patients with complex deformities ranges from 15% to 23%. Furthermore, the likelihood of a postoperative neurological deficit can be considerably increased to 83.3% in the presence of a preoperative neurological deficit. Hence, the management of pediatric spinal deformities with neurological deficits is a challenge for every spine surgeon. Here, we describe four consecutive cases of pediatric spinal deformity with myelopathic cord, all of which were managed with decompressive surgery and stabilization without any attempts to correct the deformity. All the patients recovered well neurologically, without any progression of deformity.</p><p><strong>Case presentation: </strong>The authors obtained the informed written consent from the patient and their parents for the print and electronic publication of the case. All four patients had clinical myelopathy with a progressive, worsening neurological deficit. The pathology was in the thoracic region in all the patients. Of the four cases, two were post-tubercular deformities, and two were congenital deformities. The treatment strategy for all patients was circumferential decompression of the spinal cord with posterior pedicle screw instrumentation. Although all patients had significant neurological deficits (Nurick grade 4 or 5) preoperatively, we used intraoperative neuromonitoring to prevent the worsening of the deficit during the procedure. None of the patients experienced intraoperative signal changes. All patients had significant neurological recovery (Nurick grade 0 to 2) and showed no worsening of deformity at their latest follow-up, up to 4 years. All showed good improvement in all domains of the SRS22r questionnaire.</p><p><strong>Discussion: </strong>It is challenging for spine surgeons to manage complex spinal abnormalities in pediatric patients with myelopathic cords. Even a minimal manipulation of the cord during surgery might result in severe long-term morbidity. The primary objective in managing such patients should be neurological recovery rather than deformity correction-\"First do no harm,\" and if necessary, the deformity can be corrected at a later stage under neuromonitoring.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"10 1","pages":"61"},"PeriodicalIF":0.7,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11335899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The impact of the pandemic on physical and functional disabilities in children and adolescents with spina bifida. 大流行对脊柱裂儿童和青少年身体和功能残疾的影响。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2024-08-19 DOI: 10.1038/s41394-024-00674-x
Ester da Silva Estevam, Camila Scarpino Barboza Franco, Emanuela Juvenal Martins, Danila Cristina Petian-Alonso, Karoliny Lisandra Teixeira Cruz, Ana Claudia Mattiello-Sverzut

Study design: Retrospective and cross-sectional study.

Objectives: The study aimed to carry out telemonitoring to identify the impact of the pandemic on physical and functional disabilities in children and adolescents with SB, as reported by their caregivers, and to investigate adherence to a teleservice.

Setting: Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP).

Methods: Retrospective and cross-sectional study. Fifty-three patients with SB (mean age 12.0 (4.0) years; 23 males) participated in the telemonitoring. A questionnaire - 'Health management, health conditions, rehabilitation, interest in teleservice, and the well-being of the main caregiver' - investigated the clinical impact of the coronavirus pandemic. Only three caregivers participated in the teleservice (video call).

Results: According to telemonitoring, 62% of the patients discontinued physiotherapy sessions, and 69% reported needing adjustments in locomotion devices. The main complaints were muscle weakness and pain.

Conclusion: We monitored general health and identified demands related to physical rehabilitation using telemonitoring in 42.4% of children and adolescents with SB monitored at the HCFMRP-USP. Telemonitoring and teleservice may be methods used for monitoring health conditions in patients with SB.

研究设计回顾性横断面研究:该研究旨在通过远程监测来确定大流行对患有SB的儿童和青少年的身体和功能障碍的影响(由其照顾者报告),并调查对远程服务的依从性:地点:圣保罗大学里贝朗普雷图医学院附属医院(HCFMRP-USP):回顾性横断面研究。53 名 SB 患者(平均年龄 12.0 (4.0) 岁;23 名男性)参与了远程监控。一份名为 "健康管理、健康状况、康复、对远程服务的兴趣以及主要护理人员的幸福感 "的问卷调查了冠状病毒大流行对临床的影响。只有三名护理人员参加了远程服务(视频通话):根据远程监控结果,62%的患者中断了物理治疗,69%的患者表示需要调整运动装置。主要主诉是肌肉无力和疼痛:我们通过远程监控监测了42.4%在HCFMRP-USP接受监控的患有SB的儿童和青少年的总体健康状况,并确定了与身体康复相关的需求。远程监测和远程服务可用于监测 SB 患者的健康状况。
{"title":"The impact of the pandemic on physical and functional disabilities in children and adolescents with spina bifida.","authors":"Ester da Silva Estevam, Camila Scarpino Barboza Franco, Emanuela Juvenal Martins, Danila Cristina Petian-Alonso, Karoliny Lisandra Teixeira Cruz, Ana Claudia Mattiello-Sverzut","doi":"10.1038/s41394-024-00674-x","DOIUrl":"10.1038/s41394-024-00674-x","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective and cross-sectional study.</p><p><strong>Objectives: </strong>The study aimed to carry out telemonitoring to identify the impact of the pandemic on physical and functional disabilities in children and adolescents with SB, as reported by their caregivers, and to investigate adherence to a teleservice.</p><p><strong>Setting: </strong>Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP).</p><p><strong>Methods: </strong>Retrospective and cross-sectional study. Fifty-three patients with SB (mean age 12.0 (4.0) years; 23 males) participated in the telemonitoring. A questionnaire - 'Health management, health conditions, rehabilitation, interest in teleservice, and the well-being of the main caregiver' - investigated the clinical impact of the coronavirus pandemic. Only three caregivers participated in the teleservice (video call).</p><p><strong>Results: </strong>According to telemonitoring, 62% of the patients discontinued physiotherapy sessions, and 69% reported needing adjustments in locomotion devices. The main complaints were muscle weakness and pain.</p><p><strong>Conclusion: </strong>We monitored general health and identified demands related to physical rehabilitation using telemonitoring in 42.4% of children and adolescents with SB monitored at the HCFMRP-USP. Telemonitoring and teleservice may be methods used for monitoring health conditions in patients with SB.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"10 1","pages":"60"},"PeriodicalIF":0.7,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11333677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Spinal cord injury in high-risk complex adult spinal deformity surgery: review of incidence and outcomes from the Scoli-RISK-1 study. 高风险复杂成人脊柱畸形手术中的脊髓损伤:Scoli-RISK-1 研究的发病率和结果回顾。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2024-08-17 DOI: 10.1038/s41394-024-00673-y
Fan Jiang, Hetshree Joshi, Jetan H Badhiwala, Jamie R F Wilson, Lawrence G Lenke, Christopher I Shaffrey, Kenneth M C Cheung, Leah Y Carreon, Mark B Dekutoski, Frank J Schwab, Oheneba Boachie-Adjei, Khaled M Kebaish, Christopher P Ames, Sigurd H Berven, Yong Qiu, Yukihiro Matsuyama, Benny T Dahl, Hossein Mehdian, Ferran Pellisé, Stephen J Lewis, Michael G Fehlings

Study design: Clinical case series.

Objective: To describe the cause, treatment and outcome of 6 cases of perioperative spinal cord injury (SCI) in high-risk adult deformity surgery.

Setting: Adult spinal deformity patients were enrolled in the multi-center Scoli-RISK-1 cohort study.

Methods: A total of 272 patients who underwent complex adult deformity surgery were enrolled in the prospective, multi-center Scoli-RISK-1 cohort study. Clinical follow up data were available up to a maximum of 2 years after index surgery. Cases of perioperative SCI were identified and an extensive case review was performed.

Results: Six individuals with SCI were identified from the Scoli-RISK-1 database (2.2%). Two cases occurred intraoperatively and four cases occurred postoperatively. The first case was an incomplete SCI due to a direct intraoperative insult and was treated postoperatively with Riluzole. The second SCI case was caused by a compression injury due to overcorrection of the deformity. Three cases of incomplete SCI occurred; one case of postoperative hematoma, one case of proximal junctional kyphosis (PJK) and one case of adjacent segment disc herniation. All cases of post-operative incomplete SCI were managed with revision decompression and resulted in excellent clinical recovery. One case of incomplete SCI resulted from infection and PJK. The patient's treatment was complicated by a delay in revision and the patient suffered persistent neurological deficits up to six weeks following the onset of SCI.

Conclusion: Despite the low incidence in high-risk adult deformity surgeries, perioperative SCI can result in devastating consequences. Thus, appropriate postoperative care, follow up and timely management of SCI are essential.

研究设计临床病例系列:描述高风险成人畸形手术中 6 例围手术期脊髓损伤(SCI)的原因、治疗和结果:多中心斯科利-RISK-1队列研究中的成人脊柱畸形患者:前瞻性多中心Scoli-RISK-1队列研究共纳入了272名接受复杂成人畸形手术的患者。临床随访数据最长可追溯到指数手术后两年。研究人员确定了围手术期 SCI 病例,并进行了广泛的病例回顾:结果:从Scoli-RISK-1数据库中发现了6例SCI患者(2.2%)。其中两例发生在术中,四例发生在术后。第一例是由于术中直接损伤导致的不完全 SCI,术后接受了利鲁唑治疗。第二例 SCI 是由于过度矫正畸形造成的压迫性损伤。有三例不完全脊柱损伤:一例为术后血肿,一例为近端交界性脊柱后凸(PJK),一例为邻近节段椎间盘突出。所有术后不完全脊髓损伤病例都进行了翻修减压,临床恢复良好。一例不完全脊柱损伤是由感染和 PJK 引起的。该患者的治疗因翻修延迟而变得复杂,在出现 SCI 后长达六周的时间里,患者一直存在神经功能缺损:结论:尽管高风险成人畸形手术的发生率较低,但围手术期 SCI 可导致破坏性后果。因此,适当的术后护理、随访和及时处理 SCI 至关重要。
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引用次数: 0
Venous thromboembolism: exploring incidence and utility of screening in individuals with dual diagnosis. 静脉血栓栓塞症:探讨双重诊断患者的发病率和筛查效用。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2024-08-09 DOI: 10.1038/s41394-024-00670-1
Christina Draganich, Andrew Park, Mitch Sevigny, Susan Charlifue, David Coons, Michael Makley, Raul Alvarez, James Fenton, Jeffrey Berliner

Objectives: The development of venous thromboembolism (VTE) is a common complication following spinal cord injury (SCI) and brain injury (BI), leading to significant morbidity and mortality. The purpose of this study was to explore the incidence of VTE in patients with the dual diagnosis (DD) of SCI and concomitant BI using ultrasonography.

Design: Retrospective study.

Setting: Acute rehabilitation hospital.

Participants: Thirty-one individuals admitted for DD rehabilitation who were routinely screened for VTE with ultrasound on admission.

Interventions: Not applicable.

Main outcome measures: Retrospective chart review was performed to identify whether patients were found to have DVT or PE at the following three time points: in acute care prior to admission to rehabilitation, at time of admission diagnosed via screening examination, and after admission to rehabilitation during the inpatient stay via post screening examinations. Retrospective chart review was also performed to identify incidence of bleeding.

Results: 67.7% of individuals were found to have DVTs at any timepoint. Of these DVTs, 22.6% were identified in acute care, 48.4% on admission to rehabilitation, and 16.1% during the course of rehabilitation stay. Of those who were placed on therapeutic anticoagulation due to admission diagnosis of VTE, 25% developed recurrent DVT and 12.5% had bleeding complications. No cases of PE were observed in this study population.

Conclusions: This study found a high incidence of DVT for the DD population at all three timepoints with a high proportion identified via screening ultrasonography on admission to rehabilitation. Further research is needed to investigate the incidence of VTE and utility of screening ultrasonography in this population.

目的:静脉血栓栓塞症(VTE)是脊髓损伤(SCI)和脑损伤(BI)后常见的并发症,可导致严重的发病率和死亡率。本研究的目的是利用超声波检查法探讨脊髓损伤和脑损伤双重诊断(DD)患者的 VTE 发生率:设计:回顾性研究:参与者干预措施:不适用:主要结果测量对病历进行回顾性分析,以确定患者是否在以下三个时间点被发现患有深静脉血栓或血小板增多症:入院康复治疗前的急性期、入院时通过筛查诊断出的深静脉血栓或血小板增多症,以及入院康复治疗后住院期间通过筛查后检查发现的深静脉血栓或血小板增多症。此外,还进行了回顾性病历审查,以确定出血的发生率:结果:67.7%的患者在任何时间点都被发现患有深静脉血栓。在这些深静脉血栓中,22.6%是在急性期发现的,48.4%是在入院康复时发现的,16.1%是在康复期间发现的。因入院诊断为 VTE 而接受抗凝治疗的患者中,有 25% 复发了深静脉血栓,12.5% 出现了出血并发症。本研究中未发现 PE 病例:这项研究发现,在所有三个时间点上,深静脉血栓的发生率都很高,其中很大一部分是在康复入院时通过筛查超声波检查发现的。需要进一步研究该人群中 VTE 的发生率和超声波筛查的实用性。
{"title":"Venous thromboembolism: exploring incidence and utility of screening in individuals with dual diagnosis.","authors":"Christina Draganich, Andrew Park, Mitch Sevigny, Susan Charlifue, David Coons, Michael Makley, Raul Alvarez, James Fenton, Jeffrey Berliner","doi":"10.1038/s41394-024-00670-1","DOIUrl":"10.1038/s41394-024-00670-1","url":null,"abstract":"<p><strong>Objectives: </strong>The development of venous thromboembolism (VTE) is a common complication following spinal cord injury (SCI) and brain injury (BI), leading to significant morbidity and mortality. The purpose of this study was to explore the incidence of VTE in patients with the dual diagnosis (DD) of SCI and concomitant BI using ultrasonography.</p><p><strong>Design: </strong>Retrospective study.</p><p><strong>Setting: </strong>Acute rehabilitation hospital.</p><p><strong>Participants: </strong>Thirty-one individuals admitted for DD rehabilitation who were routinely screened for VTE with ultrasound on admission.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measures: </strong>Retrospective chart review was performed to identify whether patients were found to have DVT or PE at the following three time points: in acute care prior to admission to rehabilitation, at time of admission diagnosed via screening examination, and after admission to rehabilitation during the inpatient stay via post screening examinations. Retrospective chart review was also performed to identify incidence of bleeding.</p><p><strong>Results: </strong>67.7% of individuals were found to have DVTs at any timepoint. Of these DVTs, 22.6% were identified in acute care, 48.4% on admission to rehabilitation, and 16.1% during the course of rehabilitation stay. Of those who were placed on therapeutic anticoagulation due to admission diagnosis of VTE, 25% developed recurrent DVT and 12.5% had bleeding complications. No cases of PE were observed in this study population.</p><p><strong>Conclusions: </strong>This study found a high incidence of DVT for the DD population at all three timepoints with a high proportion identified via screening ultrasonography on admission to rehabilitation. Further research is needed to investigate the incidence of VTE and utility of screening ultrasonography in this population.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"10 1","pages":"58"},"PeriodicalIF":0.7,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11315684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141913979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Outcomes 10-years after traumatic spinal cord injury in Botswana - a long-term follow-up study. 博茨瓦纳创伤性脊髓损伤 10 年后的结果--一项长期跟踪研究。
IF 0.7 Q4 CLINICAL NEUROLOGY Pub Date : 2024-08-07 DOI: 10.1038/s41394-024-00671-0
Inka Löfvenmark, Wame Mogome, Kobamelo Sekakela

Study design: Prospective follow-up study.

Objectives: To describe outcomes, survival, and attendance to routine follow-up visits 10 years post-SCI.

Setting: The national SCI-rehabilitation center in Botswana.

Methods: All persons who were admitted with traumatic SCI during a 2-year period, 2011-2013, and survived up to 2 years post-injury were included. Data were collected from the medical records from the follow-up assessment closest to 10 years post-SCI and included demographic and clinical characteristics, functional outcomes, and secondary complications. Data regarding mortalities were received from relatives. Statistical comparisons were made, when possible, between those who attend follow-up assessment and those who did not, and between those who survived up to 10 years post-SCI and those who died.

Results: The follow-up rate was 76% (19/25) of known survivors. No statistically significant factors were found to affect the follow-up rate. Secondary complications rates were for pressure ulcers and urinary tract infections 21%. Self-catheterisation and suprapubic catheter were the preferred methods to manage neurogenic bladder dysfunction. Ten persons (26%) had deceased since 2nd follow-up assessment. The causes of death were probably SCI-related in more than half of the cases.

Conclusions: This was a follow-up study at year 10 after acute TSCI in Botswana conducted at the national SCI-rehabilitation center. The study supports previous reports regarding the importance of that having specialized SCI units and the need of structured follow-ups, a responsible person in charge of scheduling, and updated patient registers. We found high follow-up rate, low rates of complications and of patients being lost to follow-up.

研究设计前瞻性随访研究:描述SCI术后10年的疗效、存活率和接受常规随访的情况:博茨瓦纳国家 SCI 康复中心:方法:纳入所有在2011-2013年两年期间因外伤性SCI入院并在伤后存活两年的患者。数据收集自创伤性脊髓损伤后最接近 10 年的随访评估病历,包括人口统计学和临床特征、功能结果和继发性并发症。有关死亡的数据来自亲属。在可能的情况下,对参加随访评估和未参加随访评估的患者进行统计比较,并对手术后存活 10 年的患者和死亡患者进行统计比较:已知幸存者的随访率为 76%(19/25)。没有发现影响随访率的有统计学意义的因素。二次并发症的发生率为压疮和尿路感染 21%。自我导尿和耻骨上导尿是治疗神经源性膀胱功能障碍的首选方法。10人(26%)在第二次随访评估后死亡。半数以上患者的死因可能与 SCI 有关:这是一项在博茨瓦纳国家 SCI 康复中心进行的急性 TSCI 术后第 10 年随访研究。这项研究支持了之前的报告,这些报告指出了设立 SCI 专科的重要性,以及进行结构化随访、安排负责人和更新患者登记册的必要性。我们发现随访率很高,并发症发生率和失去随访的病人比率都很低。
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Spinal Cord Series and Cases
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