Spinal Cord Series and Cases最新文献

{"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":"9 1","pages":"46"},"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}

{"title":"Correction: Autogenic biofeedback training improves autonomic responses in a participant with cervical motor complete spinal cord injury- case report.","authors":"Rachel D Torres,&nbsp;Hani Rashed,&nbsp;Prateek Mathur,&nbsp;Camilo Castillo,&nbsp;Thomas Abell,&nbsp;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":"9 1","pages":"45"},"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}

{"title":"Correction: Transient alteration of consciousness in spinal cord injury secondary to Baclofen use: a case report.","authors":"Thomas John Pisano,&nbsp;Jessica Ace,&nbsp;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":"9 1","pages":"44"},"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}

{"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":"9 1","pages":"43"},"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}

{"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":"9 1","pages":"41"},"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}

{"title":"Comparison of two inspiratory muscle training protocols in people with spinal cord injury: a secondary analysis.","authors":"Anne E Palermo,&nbsp;Jane E Butler,&nbsp;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_max) 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_max, 7 days/week (supervised weekly), or threshold IMT (T-IMT) at 30-80% weekly PI_max, 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_max 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_max between groups (Absolute change in PI_max (cmH₂O): p = 0.456, Percent change in PI_max 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 (% PI_max × number of breaths), p = 0.535).</p><p><strong>Conclusions: </strong>Our findings support both methods of IMT as the change in PI_max 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_max.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"9 1","pages":"42"},"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}

{"title":"Posterior cervical congenital dermal sinus tract: case report and review of literature.","authors":"Amir Vokshoor,&nbsp;Harseerat Jajj,&nbsp;Tiffany Grunwald,&nbsp;Steven Kolker,&nbsp;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":"9 1","pages":"40"},"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}

{"title":"The temporal burden of preparing catheters for re-use in adults with spinal cord injury: a cross-sectional study.","authors":"T Miller, L J Roik, T Kalimullina, S Samejima, C Shackleton, R N Malik, R Sachdeva, A V Krassioukov","doi":"10.1038/s41394-023-00596-0","DOIUrl":"10.1038/s41394-023-00596-0","url":null,"abstract":"<p><strong>Study design: </strong>Cross-sectional OBJECTIVES: Neurogenic lower urinary tract dysfunction is common among people with spinal cord injury (SCI). Although single-use clean intermittent catheterization is recommended to facilitate routine bladder emptying, catheter re-use is common. Barriers associated with the preparation (i.e., cleaning) of catheters for re-use are unknown. This study examined barriers to catheter re-use in adult individuals with SCI by assessing (1) the time needed to clean a catheter, and (2) the perceived difficulty of the catheter cleaning routine.</p><p><strong>Setting: </strong>Laboratory METHODS: Twenty individuals with chronic SCI ( ≥ 1 year since injury; Group 1 = 10 with tetraplegia; Group 2 = 10 with paraplegia) completed the study. Using a standardized cleaning procedure (i.e., Milton method), catheter cleaning was timed for each participant. Perceived difficulty was assessed using a 5-point Likert scale. Functional impairment was assessed with the Upper Extremity Motor Score (UEMS).</p><p><strong>Results: </strong>Significant between-group differences were observed for total cleaning time (Group 1 = 1584.1 ± 179.8 s; Group 2 = 1321.0 ± 93.8 s, p = 0.004) and perceived difficulty [Group 1 = 2.6 (2, 3); Group 2 = 2 (1.7, 2.3), p = 0.028]. Total cleaning time was significantly correlated with UEMS (ρ = -0.709, p ≤ 0.001) and perceived difficulty (ρ = 0.468, p = 0.037). UEMS emerged as an independent predictor of total cleaning time (R² = 0.745, β = -0.833, p ≤ 0.001).</p><p><strong>Conclusions: </strong>Preparing catheters for re-use is time-intensive and difficult for people with higher SCI level, severity and more pronounced upper limb motor impairment, which was independently associated with total cleaning time. Performing this routine on a consistent basis would require a substantial time commitment and would have a profoundly negative impact on overall quality of life.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"9 1","pages":"39"},"PeriodicalIF":0.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10393987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10307013","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}

{"title":"Para-spinal abscess presenting with abdominal pain-a case report of 'red herring' symptoms.","authors":"Mayya Vorona, James Livingstone, Farzan Dholoo","doi":"10.1038/s41394-023-00598-y","DOIUrl":"10.1038/s41394-023-00598-y","url":null,"abstract":"<p><strong>Introduction: </strong>Paraspinal abscesses are rare infections affecting the paraspinal muscles and soft tissues. An evolving abscess may pose a threat to the spinal cord via the compressive effect which can manifest as impaired motor or sensory function at the corresponding vertebral level. Paraspinal abscess is often a late diagnosis due to non-specific symptoms at presentation. This results in high morbidity and mortality.</p><p><strong>Case presentation: </strong>We describe the case of a 59-year-old female with a paraspinal abscess presenting with epigastric pain who was initially worked up for a suspected intra-abdominal pathology, however computerised tomography of the chest, abdomen, and pelvis (CTCAP) revealed no abnormality. Later, rising inflammatory markers, accompanied by worsening cervicalgia, prompted a CT of the head, neck and thorax which revealed a soft tissue abscess compressing the thecal sac at cervical levels 1 to 3 (C1-3). This was successfully managed with radiologically guided drainage and long-term intravenous antibiotics. Our patient made a full recovery and a repeat MRI demonstrated resolution of the abscess.</p><p><strong>Conclusion: </strong>We demonstrate that spinal abscess can present with a misleading combination of symptoms and highlight the importance of considering rarer differentials in the face of an evolving clinical picture. Our case also demonstrates that once the correct diagnosis is reached, patients can make an excellent recovery from uncomplicated spinal abscesses.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"9 1","pages":"38"},"PeriodicalIF":0.7,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10390549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9986544","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}

{"title":"Spinal Rosai-Dorfman disease-a report of 2 cases and review of literature.","authors":"Saumyajit Basu, Rohan Gala, Kushal Gohil","doi":"10.1038/s41394-023-00600-7","DOIUrl":"10.1038/s41394-023-00600-7","url":null,"abstract":"<p><strong>Introduction: </strong>Rosai-Dorfman Disease (RDD) is a rare benign histiocytic disease that infrequently affects the spine. We report two cases of spinal RDD and review the relevant literature. This report addresses the various diagnostic dilemmas related to the evaluation of Spinal RDD and its treatment.</p><p><strong>Case presentation: </strong>Case 1: A 32-year-old male presented with low back pain and left anterior thigh for last 8 months. On examination, there was sensory diminution on inner aspects of the thigh with an absent left knee jerk. CT/MRI scans revealed an extradural lesion at L2/3 with neural compression. PET scan showed several hypermetabolic lesions in ribs, humerus, femur, and vertebrae. He underwent en bloc excision of the extradural mass with L2-3 pedicle screw-rod fixation and was later managed with chemotherapy. Case 2: A 42-year-old male presented with spastic paraparesis with urinary incontinence for the last 4 weeks. On examination, he had a neurological level of T6. MRI scan revealed a lesion in posterior elements of T6-7 compressing the spinal cord. He underwent T6-7 laminectomy with decompression. In both cases, the diagnosis was confirmed by histopathology and further managed by Hemato-oncologist. They both did well at 1-year follow-up with improvement in neurology.</p><p><strong>Discussion: </strong>Spinal RDD to date remains a large diagnostic dilemma with no pathognomonic clinical or radiological features; mimicking many osteolytic lesions in the spine. The diagnosis is purely histopathological and immunological. The lesion's complete surgical excision is the mainstay of treatment with a better prognosis and decreased chances of recurrences.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"9 1","pages":"36"},"PeriodicalIF":0.7,"publicationDate":"2023-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10387076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9973629","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}