Pub Date : 2023-10-05DOI: 10.1038/s41394-023-00605-2
Gwenaelle Schackis, Tuan Le Van, Ahmed El Cadhi, Marc Lenfant, François Borsotti, Philibert Alixant
We present an extremely infrequent case of intradural metastasis of a parotid tumour, responsible for motor deficit in legs. To our knowledge, this is the first reported case of an intradural metastasis of a malignant and rare parotid tumour, oncocytic carcinoma. It accounts for less than 1% of salivary gland tumours. Its management is not codified and its prognosis seems to be poor. Local recurrences are common, as are regional metastases. Distant metastases are present in less than 30% of cases and are poorly described, mainly involving the lung. Thanks to the surgical treatment, our patient has partially recovered his motor and sensory functions.
{"title":"Intradural extramedullary metastasis of oncocytic carcinoma of the parotid gland: A first case report and review of the literature.","authors":"Gwenaelle Schackis, Tuan Le Van, Ahmed El Cadhi, Marc Lenfant, François Borsotti, Philibert Alixant","doi":"10.1038/s41394-023-00605-2","DOIUrl":"10.1038/s41394-023-00605-2","url":null,"abstract":"<p><p>We present an extremely infrequent case of intradural metastasis of a parotid tumour, responsible for motor deficit in legs. To our knowledge, this is the first reported case of an intradural metastasis of a malignant and rare parotid tumour, oncocytic carcinoma. It accounts for less than 1% of salivary gland tumours. Its management is not codified and its prognosis seems to be poor. Local recurrences are common, as are regional metastases. Distant metastases are present in less than 30% of cases and are poorly described, mainly involving the lung. Thanks to the surgical treatment, our patient has partially recovered his motor and sensory functions.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10556077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41128706","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}
Pub Date : 2023-09-08DOI: 10.1038/s41394-023-00603-4
Brett F Wegenast, Tara A Whitten, Jeffrey A Bakal, Lea Bill, Adalberto Loyola-Sanchez
Study design: Retrospective observational cohort study.
Objectives: Estimate spinal cord injury (SCI) prevalence in First Nations and non-First Nations populations and compare healthcare utilization as an indirect marker of health inequities.
Setting: Alberta, Canada.
Methods: We created a prevalent adult SCI cohort by identifying cases between April 1, 2002 and December 31, 2017 who were followed for common SCI complications and location of healthcare access from January 1, 2018 to December 31, 2019 using administrative data sources housed within Alberta Health Services (AHS). First Nations and non-First Nations SCI cohorts were divided into SCI etiology: traumatic SCI (TSCI) and non-traumatic SCI (NTSCI). Statistical analyses compared prevalence, demographics, healthcare utilization, and SCI complication rates. A secondary analysis was performed using case matching for demographics, injury type, injury level, and comorbidities.
Results: TSCI prevalence: 248 and 117 per 100,000 in First Nations and non-First Nations cohorts, respectively. NTSCI prevalence: 74 and 50 per 100,000 in First Nations and non-First Nations cohorts, respectively. Visit rates were higher in the TSCI First Nations cohort for visits to General Practitioner (GP), Emergency Department (ED), inpatient visits, and inpatient days with higher complication rates due to pulmonary, genitourinary, skin, and 'other' causes after case matching. Visits rates were higher in the NTSCI First Nations cohort for GP and specialists without differences in complication types after case matching.
Conclusions: Significant differences exist between First Nations and non-First Nations cohorts living with SCI in Alberta, suggesting healthcare inequities against First Nations Peoples in this province.
{"title":"Epidemiology and healthcare utilization of First Nations peoples living with spinal cord injury in Alberta: an observational study to explore health inequities.","authors":"Brett F Wegenast, Tara A Whitten, Jeffrey A Bakal, Lea Bill, Adalberto Loyola-Sanchez","doi":"10.1038/s41394-023-00603-4","DOIUrl":"https://doi.org/10.1038/s41394-023-00603-4","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective observational cohort study.</p><p><strong>Objectives: </strong>Estimate spinal cord injury (SCI) prevalence in First Nations and non-First Nations populations and compare healthcare utilization as an indirect marker of health inequities.</p><p><strong>Setting: </strong>Alberta, Canada.</p><p><strong>Methods: </strong>We created a prevalent adult SCI cohort by identifying cases between April 1, 2002 and December 31, 2017 who were followed for common SCI complications and location of healthcare access from January 1, 2018 to December 31, 2019 using administrative data sources housed within Alberta Health Services (AHS). First Nations and non-First Nations SCI cohorts were divided into SCI etiology: traumatic SCI (TSCI) and non-traumatic SCI (NTSCI). Statistical analyses compared prevalence, demographics, healthcare utilization, and SCI complication rates. A secondary analysis was performed using case matching for demographics, injury type, injury level, and comorbidities.</p><p><strong>Results: </strong>TSCI prevalence: 248 and 117 per 100,000 in First Nations and non-First Nations cohorts, respectively. NTSCI prevalence: 74 and 50 per 100,000 in First Nations and non-First Nations cohorts, respectively. Visit rates were higher in the TSCI First Nations cohort for visits to General Practitioner (GP), Emergency Department (ED), inpatient visits, and inpatient days with higher complication rates due to pulmonary, genitourinary, skin, and 'other' causes after case matching. Visits rates were higher in the NTSCI First Nations cohort for GP and specialists without differences in complication types after case matching.</p><p><strong>Conclusions: </strong>Significant differences exist between First Nations and non-First Nations cohorts living with SCI in Alberta, suggesting healthcare inequities against First Nations Peoples in this province.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10484972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10239061","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}
Pub Date : 2023-09-06DOI: 10.1038/s41394-023-00578-2
Zahra Ghodsi, Seyed Behnam Jazayeri, Ahmad Pourrashidi, Mohsen Sadeghi-Naeini, Zahra Azadmanjir, Vali Baigi, Seyed Farzad Maroufi, Amir Azarhomayoun, Morteza Faghih-Jouybari, Abbas Amirjamshidi, Khatereh Naghdi, Roya Habibi Arejan, Maryam Shabani, Arvin Sepahdoost, Hojat Dehghanbanadaki, Reza Habibi, Mahdi Mohammadzadeh, Maryam Bahreini, Gerard Michael O'Reilly, Alexander R Vaccaro, James S Harrop, Benjamin M Davies, Lu Yi, Seyed Mohammad Ghodsi, Vafa Rahimi-Movaghar
{"title":"Correction to: Development of a comprehensive assessment tool to measure the quality of care for individuals with traumatic spinal cord injuries.","authors":"Zahra Ghodsi, Seyed Behnam Jazayeri, Ahmad Pourrashidi, Mohsen Sadeghi-Naeini, Zahra Azadmanjir, Vali Baigi, Seyed Farzad Maroufi, Amir Azarhomayoun, Morteza Faghih-Jouybari, Abbas Amirjamshidi, Khatereh Naghdi, Roya Habibi Arejan, Maryam Shabani, Arvin Sepahdoost, Hojat Dehghanbanadaki, Reza Habibi, Mahdi Mohammadzadeh, Maryam Bahreini, Gerard Michael O'Reilly, Alexander R Vaccaro, James S Harrop, Benjamin M Davies, Lu Yi, Seyed Mohammad Ghodsi, Vafa Rahimi-Movaghar","doi":"10.1038/s41394-023-00578-2","DOIUrl":"10.1038/s41394-023-00578-2","url":null,"abstract":"","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10482847/pdf/41394_2023_Article_578.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10177184","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}
Pub Date : 2023-09-05DOI: 10.1038/s41394-023-00604-3
Brendan F Judy, Jovanna A Tracz, Jordina Rincon-Torroella, A Karim Ahmed, Timothy F Witham
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.
{"title":"Reduction of cervicothoracic spondyloptosis in an ambulatory patient: when traction fails.","authors":"Brendan F Judy, Jovanna A Tracz, Jordina Rincon-Torroella, A Karim Ahmed, Timothy F Witham","doi":"10.1038/s41394-023-00604-3","DOIUrl":"10.1038/s41394-023-00604-3","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Case presentation: </strong>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.</p><p><strong>Discussion: </strong>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.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10477183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10237114","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}
Pub Date : 2023-08-24DOI: 10.1038/s41394-023-00602-5
Rachel D Torres, Hani Rashed, Prateek Mathur, Camilo Castillo, Thomas Abell, Daniela G L Terson de Paleville
{"title":"Correction: Autogenic biofeedback training improves autonomic responses in a participant with cervical motor complete spinal cord injury- case report.","authors":"Rachel D Torres, Hani Rashed, Prateek Mathur, Camilo Castillo, Thomas Abell, Daniela G L Terson de Paleville","doi":"10.1038/s41394-023-00602-5","DOIUrl":"https://doi.org/10.1038/s41394-023-00602-5","url":null,"abstract":"","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10449901/pdf/41394_2023_Article_602.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10065383","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}
Pub Date : 2023-08-18DOI: 10.1038/s41394-023-00601-6
Thomas John Pisano, Jessica Ace, Beverly Hon
{"title":"Correction: Transient alteration of consciousness in spinal cord injury secondary to Baclofen use: a case report.","authors":"Thomas John Pisano, Jessica Ace, Beverly Hon","doi":"10.1038/s41394-023-00601-6","DOIUrl":"https://doi.org/10.1038/s41394-023-00601-6","url":null,"abstract":"","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10439153/pdf/41394_2023_Article_601.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10413443","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}
Pub Date : 2023-08-14DOI: 10.1038/s41394-023-00599-x
K MacKay, E J McCaughey, N Fullerton, M Purcell
Introduction: Pyogenic spinal infections (PSI) are a rare cause of spinal cord injury (SCI). These most often affect the lumbar spine, followed by the thoracic spine and least commonly the cervical spine, with Staphylococcus aureus being the most common causative organism. Atopic eczema is a dermatological condition which can lead to a breakdown of the skin's natural barrier function, allowing bacterial colonisation and infection. Haematological seeding of bacteria from a distant source of infection, including the skin and soft tissues, is a recognised aetiology of PSI.
Case presentation: We present two patients who sustained a SCI as a result of PSI secondary to infected atopic eczema. Methicillin-sensitive Staphylococcus aureus (MSSA) was identified as the causative organism in both patients. The two patients required prolonged courses of intravenous followed by oral antibiotics. Neurological outcomes varied between the two patients. One patient had incomplete tetraplegia (C3 AIS C), and upon discharge required hoisting from their bed to a power chair, had an indwelling urethral catheter and required bowel care. The other patient had incomplete paraplegia (L3 AIS D), and at discharge was independent with activities of daily living and was mobile with two elbow crutches.
Discussion: We believe that the two cases presented here represent the only examples of secondarily infected atopic eczema causing PSI and resultant SCI in the published literature. As SCI is a serious and potentially life-altering complication, medical professionals treating patients with atopic eczema should be aware of this risk.
{"title":"Spinal cord injury as a result of Staphylococcus aureus pyogenic spinal infection complicating infected atopic eczema: two case reports.","authors":"K MacKay, E J McCaughey, N Fullerton, M Purcell","doi":"10.1038/s41394-023-00599-x","DOIUrl":"10.1038/s41394-023-00599-x","url":null,"abstract":"<p><strong>Introduction: </strong>Pyogenic spinal infections (PSI) are a rare cause of spinal cord injury (SCI). These most often affect the lumbar spine, followed by the thoracic spine and least commonly the cervical spine, with Staphylococcus aureus being the most common causative organism. Atopic eczema is a dermatological condition which can lead to a breakdown of the skin's natural barrier function, allowing bacterial colonisation and infection. Haematological seeding of bacteria from a distant source of infection, including the skin and soft tissues, is a recognised aetiology of PSI.</p><p><strong>Case presentation: </strong>We present two patients who sustained a SCI as a result of PSI secondary to infected atopic eczema. Methicillin-sensitive Staphylococcus aureus (MSSA) was identified as the causative organism in both patients. The two patients required prolonged courses of intravenous followed by oral antibiotics. Neurological outcomes varied between the two patients. One patient had incomplete tetraplegia (C3 AIS C), and upon discharge required hoisting from their bed to a power chair, had an indwelling urethral catheter and required bowel care. The other patient had incomplete paraplegia (L3 AIS D), and at discharge was independent with activities of daily living and was mobile with two elbow crutches.</p><p><strong>Discussion: </strong>We believe that the two cases presented here represent the only examples of secondarily infected atopic eczema causing PSI and resultant SCI in the published literature. As SCI is a serious and potentially life-altering complication, medical professionals treating patients with atopic eczema should be aware of this risk.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10425448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10229388","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}
Pub Date : 2023-08-12DOI: 10.1038/s41394-023-00595-1
Glenn A Gonzalez, Jingya Miao, Guilherme Porto, James Harrop
Introduction: Delayed C5 weakness is a known entity in cervical spine surgery, although with varied clinical presentation and poorly understood mechanism of action. We describe the first case in the literature of a bilateral C5 palsy leading to bilateral phrenic nerve dysfunction following a posterior cervical decompression and fusion.
Case report: A 76-year-old male presented with low back pain and was diagnosed as myelopathic. On initial neurological examination, he could not ambulate without assistance and was unsteady on tandem gait. The initial cervical MRI and CT scan showed advanced multilevel degenerative changes of the cervical spine with severe cord compression and myelomalacia. The patient underwent C3-C6 posterior cervical decompression & fusion (PCDF). He awoke with his baseline examination without neurophysiological monitoring changes intraoperatively or C5 root EMG activity. Post-operative MRI of the cervical spine was performed and showed an excellent decompression. The patient was neurologically stable and discharged to a rehabilitation facility. Patient developed a delayed bilateral C5P on postoperative day (POD) 74. Delayed bilateral C5P and phrenic nerve damage was determined to cause this patient's dyspnea. PM&R consult recommended placement of diaphragmatic pacers. However, clinically his respiratory function, as well as motor deficits, have gradually improved.
Conclusion: Bilateral diaphragmatic paralysis, a severe complication of cervical spine surgery, may cause respiratory distress and upper limb weakness. C5P, the underlying cause, may arise from various factors. Early detection and management of diaphragmatic weakness with physical therapy and pacers are crucial, emphasizing the need for vigilance by healthcare professionals and surgeons.
{"title":"Bilateral phrenic nerve palsy after posterior cervical decompression and fusion surgery: a rare event after surgery.","authors":"Glenn A Gonzalez, Jingya Miao, Guilherme Porto, James Harrop","doi":"10.1038/s41394-023-00595-1","DOIUrl":"10.1038/s41394-023-00595-1","url":null,"abstract":"<p><strong>Introduction: </strong>Delayed C5 weakness is a known entity in cervical spine surgery, although with varied clinical presentation and poorly understood mechanism of action. We describe the first case in the literature of a bilateral C5 palsy leading to bilateral phrenic nerve dysfunction following a posterior cervical decompression and fusion.</p><p><strong>Case report: </strong>A 76-year-old male presented with low back pain and was diagnosed as myelopathic. On initial neurological examination, he could not ambulate without assistance and was unsteady on tandem gait. The initial cervical MRI and CT scan showed advanced multilevel degenerative changes of the cervical spine with severe cord compression and myelomalacia. The patient underwent C3-C6 posterior cervical decompression & fusion (PCDF). He awoke with his baseline examination without neurophysiological monitoring changes intraoperatively or C5 root EMG activity. Post-operative MRI of the cervical spine was performed and showed an excellent decompression. The patient was neurologically stable and discharged to a rehabilitation facility. Patient developed a delayed bilateral C5P on postoperative day (POD) 74. Delayed bilateral C5P and phrenic nerve damage was determined to cause this patient's dyspnea. PM&R consult recommended placement of diaphragmatic pacers. However, clinically his respiratory function, as well as motor deficits, have gradually improved.</p><p><strong>Conclusion: </strong>Bilateral diaphragmatic paralysis, a severe complication of cervical spine surgery, may cause respiratory distress and upper limb weakness. C5P, the underlying cause, may arise from various factors. Early detection and management of diaphragmatic weakness with physical therapy and pacers are crucial, emphasizing the need for vigilance by healthcare professionals and surgeons.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10423263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10237520","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}
Pub Date : 2023-08-12DOI: 10.1038/s41394-023-00594-2
Anne E Palermo, Jane E Butler, Claire L Boswell-Ruys
Study design/setting: Secondary analysis.
Objectives: To compare the change in maximal inspiratory pressure (PImax) over the first 4 weeks of two different inspiratory muscle training (IMT) protocols and explore if either method is more effective for people with spinal cord injury.
Methods: Data originated from two published studies. Participants completed flow-resistive IMT (F-IMT) at 80% daily PImax, 7 days/week (supervised weekly), or threshold IMT (T-IMT) at 30-80% weekly PImax, twice-daily, 5 days/week (supervised every session). Seven participants from each trial were matched by training adherence, level of spinal cord injury, impairment grade (A-C), and height. Differences between F-IMT and T-IMT groups in training intensity, breaths taken, inspiratory work, and the change in the PImax from baseline at the end of week four were analysed.
Results: Over 4 weeks, there was no difference in the change in PImax between groups (Absolute change in PImax (cmH2O): p = 0.456, Percent change in PImax relative to baseline: p = 0.128). F-IMT participants trained at a higher intensity (median: 77 vs 22 cmH2O, p = 0.001 and 80% baseline vs 61% baseline, p = 0.038) but took fewer breaths (840 vs 1404 breaths, p = 0.017) than T-IMT participants. Inspiratory work was similar between groups (64,789 vs 65,910 (% PImax × number of breaths), p = 0.535).
Conclusions: Our findings support both methods of IMT as the change in PImax and inspiratory work were similar between groups. However, daily high-intensity F-IMT with intermittent supervision, required fewer breaths and less participant and therapist time. Future studies should examine optimal dosage and supervision required to achieve increased PImax.
研究设计/设置:二次分析。目的:比较两种不同的吸气肌训练(IMT)方案前4周最大吸气压力(PImax)的变化,并探讨哪种方法对脊髓损伤患者更有效。方法:数据来源于两项已发表的研究。参与者完成流动阻力IMT (F-IMT)在80%的每日PImax,每周7天(监督每周),或阈值IMT (T-IMT)在30-80%的每周PImax,每天两次,每周5天(监督每次)。每个试验的7名参与者按照训练依从性、脊髓损伤程度、损伤等级(A-C)和身高进行匹配。分析F-IMT组和T-IMT组在训练强度、呼吸量、吸气功以及第四周结束时基线的PImax变化方面的差异。结果:在4周内,两组间PImax的变化无差异(PImax的绝对变化(cmH2O): p = 0.456, PImax相对于基线的百分比变化:p = 0.128)。F-IMT参与者训练强度更高(中位数:77 cmH2O vs 22 cmH2O, p = 0.001, 80%基线vs 61%基线,p = 0.038),但比T-IMT参与者呼吸次数更少(840对1404次呼吸,p = 0.017)。两组之间的吸气功相似(64,789 vs 65,910 (% PImax ×呼吸次数),p = 0.535)。结论:我们的研究结果支持两种IMT方法,因为两组之间PImax和吸气功的变化相似。然而,每日高强度的间歇监督的F-IMT需要更少的呼吸和更少的参与者和治疗师的时间。未来的研究应检查最佳剂量和所需的监督,以达到增加PImax。
{"title":"Comparison of two inspiratory muscle training protocols in people with spinal cord injury: a secondary analysis.","authors":"Anne E Palermo, Jane E Butler, Claire L Boswell-Ruys","doi":"10.1038/s41394-023-00594-2","DOIUrl":"https://doi.org/10.1038/s41394-023-00594-2","url":null,"abstract":"<p><strong>Study design/setting: </strong>Secondary analysis.</p><p><strong>Objectives: </strong>To compare the change in maximal inspiratory pressure (PI<sub>max</sub>) over the first 4 weeks of two different inspiratory muscle training (IMT) protocols and explore if either method is more effective for people with spinal cord injury.</p><p><strong>Methods: </strong>Data originated from two published studies. Participants completed flow-resistive IMT (F-IMT) at 80% daily PI<sub>max,</sub> 7 days/week (supervised weekly), or threshold IMT (T-IMT) at 30-80% weekly PI<sub>max,</sub> twice-daily, 5 days/week (supervised every session). Seven participants from each trial were matched by training adherence, level of spinal cord injury, impairment grade (A-C), and height. Differences between F-IMT and T-IMT groups in training intensity, breaths taken, inspiratory work, and the change in the PI<sub>max</sub> from baseline at the end of week four were analysed.</p><p><strong>Results: </strong>Over 4 weeks, there was no difference in the change in PI<sub>max</sub> between groups (Absolute change in PI<sub>max</sub> (cmH<sub>2</sub>O): p = 0.456, Percent change in PI<sub>max</sub> relative to baseline: p = 0.128). F-IMT participants trained at a higher intensity (median: 77 vs 22 cmH<sub>2</sub>O, p = 0.001 and 80% baseline vs 61% baseline, p = 0.038) but took fewer breaths (840 vs 1404 breaths, p = 0.017) than T-IMT participants. Inspiratory work was similar between groups (64,789 vs 65,910 (% PI<sub>max</sub> × number of breaths), p = 0.535).</p><p><strong>Conclusions: </strong>Our findings support both methods of IMT as the change in PI<sub>max</sub> and inspiratory work were similar between groups. However, daily high-intensity F-IMT with intermittent supervision, required fewer breaths and less participant and therapist time. Future studies should examine optimal dosage and supervision required to achieve increased PI<sub>max</sub>.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10423237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10229374","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}
Pub Date : 2023-08-02DOI: 10.1038/s41394-023-00575-5
Amir Vokshoor, Harseerat Jajj, Tiffany Grunwald, Steven Kolker, Jack Petros
Background and importance: Congenital dermal sinus tract (DST) is a rare spinal dysraphism characterized by a persistent tract lined by epithelial cells, beginning at the epidermis and terminating in deeper tissue layers. With 1% of all congenital DST cases found in the cervical region, only 4% of all cases are diagnosed after the age of 20.
Clinical presentation: In this case, a 65-year-old woman with a congenital DST at the cervical level presented with symptoms of neck and some arm pain, suboccipital headaches, and unique external characteristics. Neck Disability Index and visual analog scale were used to assess the patient's preoperative and postoperative pain, and quality of life. Patient underwent an operative intervention, where the DST was surgically removed followed by interlaminar decompression at C1-C2, excision of the epidural component, and biopsy followed by plastic surgical repair. Pathology analysis indicated a squamous epithelial-lined sinus tract interacting with the dura. Most notably, a meningothelial proliferation with associated psammomatous calcifications was identified, similar to a meningioma.
Conclusion: A review of literature was conducted to further discuss clinical and radiological presentation as well as to document the novel appearance of this congenital DST. As one of the oldest cases of DST, it demonstrated unusual pathological characteristics with a meningothelial proliferation, compatible with meningioma, reported at the epidural level.
{"title":"Posterior cervical congenital dermal sinus tract: case report and review of literature.","authors":"Amir Vokshoor, Harseerat Jajj, Tiffany Grunwald, Steven Kolker, Jack Petros","doi":"10.1038/s41394-023-00575-5","DOIUrl":"https://doi.org/10.1038/s41394-023-00575-5","url":null,"abstract":"<p><strong>Background and importance: </strong>Congenital dermal sinus tract (DST) is a rare spinal dysraphism characterized by a persistent tract lined by epithelial cells, beginning at the epidermis and terminating in deeper tissue layers. With 1% of all congenital DST cases found in the cervical region, only 4% of all cases are diagnosed after the age of 20.</p><p><strong>Clinical presentation: </strong>In this case, a 65-year-old woman with a congenital DST at the cervical level presented with symptoms of neck and some arm pain, suboccipital headaches, and unique external characteristics. Neck Disability Index and visual analog scale were used to assess the patient's preoperative and postoperative pain, and quality of life. Patient underwent an operative intervention, where the DST was surgically removed followed by interlaminar decompression at C1-C2, excision of the epidural component, and biopsy followed by plastic surgical repair. Pathology analysis indicated a squamous epithelial-lined sinus tract interacting with the dura. Most notably, a meningothelial proliferation with associated psammomatous calcifications was identified, similar to a meningioma.</p><p><strong>Conclusion: </strong>A review of literature was conducted to further discuss clinical and radiological presentation as well as to document the novel appearance of this congenital DST. As one of the oldest cases of DST, it demonstrated unusual pathological characteristics with a meningothelial proliferation, compatible with meningioma, reported at the epidural level.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2023-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10397304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9945272","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}