Spinal Cord Series and Cases最新文献

{"title":"Delayed spinal arachnoiditis with syringomyelia following aneurysmal subarachnoid haemorrhage: a case report with patient experience.","authors":"Nityanand Jain, Liga Jaunozolina, Inga Putraima, Kaspars Auslands, Andrejs Millers","doi":"10.1038/s41394-024-00654-1","DOIUrl":"10.1038/s41394-024-00654-1","url":null,"abstract":"<p><strong>Background and importance: </strong>Syringomyelia, or the formation of fluid-filled cysts within the spinal cord, associated with delayed spinal arachnoiditis is an uncommon complication of aneurysmal subarachnoid haemorrhage. To date, about 18 cases have been reported in medical literature, with just two reported in patients under the age of 35 years.</p><p><strong>Clinical presentation: </strong>A 27-year-old female patient complained of sudden, severe headaches in the occipital region, nuchal rigidity, and drowsiness when she presented at our institution. A head computed tomography scan revealed intraventricular bleeding in the lateral and fourth ventricles with more extensive haemorrhaging in the frontal horns. A left posterior inferior cerebellar artery (PICA) aneurysm was confirmed via digital subtraction angiogram, and endovascular embolization was done. Two years later, the patient reported intense pain in the lower back along with symptoms suggestive of spinal cord compression. Spinal magnetic resonance imaging (MRI) showed spinal adhesions from C1 to L4, syringomyelia with some vasogenic oedema extending from T3 to T9 level, and a cyst in the lumbar region. Consequently, a right hemilaminectomy was performed along with microsurgical release of arachnoid adhesions and placement of a subdural drain. Radiological and symptomatic improvements were observed. Since then, the patient's clinical condition has remained stable during the past three years of follow-up visits.</p><p><strong>Conclusions: </strong>Literature on optimal treatment modalities and patient prognosis is scarce and debated. The time for symptom improvement depends on the level and extent of spinal cord involvement. Rehabilitation may be required for most patients, as complete symptomatic recovery may not be attainable.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"10 1","pages":"41"},"PeriodicalIF":0.7,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11165000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141301606","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":"A physiatrist's role in managing unique challenges in pregnancy and delivery in a patient with incomplete lumbar SCI: a case report.","authors":"Lauren Hall, Connie Hsu, Chloe Slocum, John Lowry","doi":"10.1038/s41394-024-00652-3","DOIUrl":"10.1038/s41394-024-00652-3","url":null,"abstract":"<p><strong>Introduction: </strong>Women of childbearing age make up around 5-10% of individuals with spinal cord injury (SCI) and may face unique medical and functional complications during pregnancy, including prolonged hospitalization and increased risk of early rehospitalization due to falls.</p><p><strong>Case presentation: </strong>Here, we discuss a case of a young ambulatory woman with a lumbar motor incomplete spinal cord injury who underwent successful delivery via cesarean section and the role of the physiatrist in the management of the patient's antepartum, intrapartum, and postpartum complications. The patient faced significant antepartum challenges secondary to her neurogenic bladder and pelvic floor weakness, resulting in increased use of her manual wheelchair. The physiatry team assisted with the co-development of a multidisciplinary bladder plan for increased urinary frequency and urinary tract infection prevention with the patient's obstetrics physician (OB). In addition, the physiatry team assisted with the procurement of a new wheelchair suited for the patient's pregnancy and childcare needs in anticipation of decreased mobility during this time. Regarding intrapartum challenges, the physiatry team worked with the patient and her OB to develop a safe birth plan considering the method of delivery, epidural usage, and the need for pelvic floor therapy before and after childbirth.</p><p><strong>Discussion: </strong>The patient had a successful cesarean section delivery, with return to independent mobility soon after childbirth. In summary, this case demonstrates that there is a need for a multidisciplinary approach to patients with SCI during pregnancy and that the role of physiatry is critical to optimizing medical and functional outcomes.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"10 1","pages":"40"},"PeriodicalIF":1.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11150403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141248588","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":"Intermittent catheterisation: individuals' rights, accessibility, and environmental concerns.","authors":"Andrei Krassioukov, Michel Wyndaele, Matthias Walter, Veronique Keppenne, Blayne Welk, Desiree Vrijens, Francois Theron","doi":"10.1038/s41394-024-00651-4","DOIUrl":"10.1038/s41394-024-00651-4","url":null,"abstract":"","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"10 1","pages":"39"},"PeriodicalIF":0.7,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11143204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141184636","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":"Surgical treatment for recurrent thoracic ventral intradural arachnoid cyst secondary to tuberculous meningitis: a case report.","authors":"Yushi Sakamoto, Takayoshi Shimizu, Bungo Otsuki, Shuichi Matsuda","doi":"10.1038/s41394-024-00650-5","DOIUrl":"10.1038/s41394-024-00650-5","url":null,"abstract":"<p><strong>Introduction: </strong>Spinal intradural arachnoid cysts (SIACs) are rare spinal entities that are categorized as primary or secondary pathologies. Secondary cysts can arise from various traumatic or inflammatory causes including subarachnoid hemorrhage, intrathecal injection or surgery, and infectious meningitis/arachnoiditis. Only a few cases of SIAC secondary to tuberculous meningitis have been previously reported, without details of the surgical treatment.</p><p><strong>Case presentation: </strong>A 27-year-old woman diagnosed with tuberculous meningitis developed myelopathy caused by thoracic ventral SIAC and intradural abscess. The patient underwent abscess evacuation and cyst fenestration; however, cyst recurrence occurred. The 2nd surgery consisted of cyst resection via a posterolateral approach with expansive duraplasty and spinal arthrodesis. Re-recurrence occurred, and at the 3rd surgery, cyst-subarachnoid bypass was performed. One year after the 3rd surgery, the myelopathic symptoms recovered, and MR images demonstrated a decreased cyst size.</p><p><strong>Discussion: </strong>Here, we report a rare case of recurrent thoracic SIAC secondary to tuberculous meningitis and arachnoiditis. Simple fenestration is associated with a high risk of recurrence in this pathology. Ventrally located thoracic cysts can be approached with posterolateral approach with pedicles resected followed by instrumented arthrodesis. Even in cases involving gross total resection of the cyst wall, there is a risk of recurrence. In such cases, cyst-subarachnoid bypass with a large-diameter tube can be effective.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"10 1","pages":"36"},"PeriodicalIF":0.7,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11116473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141088974","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":"Cauda equina syndrome with surgical intervention in pregnancy during the periviable period.","authors":"Mary Taylor Winsten, Jessica Fine, Fatimah Fahimuddin, Diana Baxter, Tamika Auguste","doi":"10.1038/s41394-024-00646-1","DOIUrl":"10.1038/s41394-024-00646-1","url":null,"abstract":"<p><strong>Introduction: </strong>Cauda equina syndrome (CES) following lumbar disc herniation is exceedingly rare in pregnancy and there is limited literature outlining management of CES in pregnancy. There is further limited data addressing the management of periviable pregnancies complicated by CES.</p><p><strong>Case presentation: </strong>A 38-year-old female at 22 weeks gestation presented with worsening lower back pain radiating to the right posterior lower extremity. She was initially managed with conservative therapy, but re-presented with worsening neurologic symptoms, including fasciculations and perineal numbness. Magnetic resonance imaging showed a large herniated disc at L4-5, and given concern for CES, she underwent emergent decompression surgery, which was complicated by a superficial wound dehiscence. She ultimately carried her pregnancy to term and had a cesarean delivery. The patient's residual neurologic symptoms continued to improve with physical therapy throughout the postpartum period.</p><p><strong>Discussion: </strong>Cauda equina syndrome is a rare spinal condition with potentially devastating outcomes if not managed promptly. Diagnosis and management of CES in pregnancy is the same as in non-pregnant patients, however, standardization of patient positioning for surgery, surgical approach, anesthetic use, and fetal considerations is lacking. A multidisciplinary approach is critical, especially at periviable gestational ages of pregnancy. Our case and review of the literature demonstrates that patients in the second trimester can be managed surgically with prone positioning, intermittent fetal monitoring, and continued management of the pregnancy remains unchanged. Given the rarity of these cases, there is a need for a consensus on management and continued care in pregnant patients with CES.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"10 1","pages":"35"},"PeriodicalIF":1.2,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11088644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140908784","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":"On Professor Robert Lipschitz, MB, ChB, PhD(Med), FRCS(Edin) and the Spinal Cord Injury Service, Chris Hani Baragwanath Hospital, Soweto, Johannesburg, South Africa.","authors":"Avi Ohry","doi":"10.1038/s41394-024-00645-2","DOIUrl":"10.1038/s41394-024-00645-2","url":null,"abstract":"<p><p>Professor Robert Lipschitz, MB, ChB, PhD(Med), FRCS(Edin) was a pioneer who established the Spinal Cord Injury Unit, at Chris Hani Baragwanath Hospital, Soweto, Johannesburg, South Africa. A brief description of his academic and clinical accomplishments is given.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"10 1","pages":"34"},"PeriodicalIF":1.2,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11076579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140877362","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":"Combined rehabilitation therapy with botulinum toxin to the upper limbs for acute spinal cord injury: A case report","authors":"Haruki Mori, Gosuke Satoh, Hideki Takashima, Takashi Masuda, Tomoo Mano","doi":"10.1038/s41394-024-00647-0","DOIUrl":"https://doi.org/10.1038/s41394-024-00647-0","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>Patients with spinal cord injury (SCI) and incomplete paralysis may experience muscle immobilization due to functional impairment of agonist and antagonist muscles. This can induce spasticity and pain, with the risk of contracture increasing as the period of immobilization increases. This could be aggravated by pain, which interferes with rehabilitation. There is no established treatment for pain and joint contractures caused by acute SCI. Botulinum therapy plays a role in relieving muscle tension. Here, we report a case of acute SCI in which botulinum therapy was administered.</p><h3 data-test=\"abstract-sub-heading\">Case presentation</h3><p>The patient experienced a C5-cervical SCI due to a road traffic accident, with marked paralysis in the upper and lower limbs below the C5 level. The patient had persistent elbow flexion since the SCI and complained of excruciating pain, making adequate rehabilitation difficult. Botulinum toxin was administered to the biceps and brachialis muscles 15 days after the SCI. After administration, the patient experienced a reduction in pain with relaxation of the elbow flexor muscles, and rehabilitation treatment was resumed. This patient’s contracture did not worsen, his pain decreased, and he was able to initiate self-feeding training.</p><h3 data-test=\"abstract-sub-heading\">Discussion</h3><p>In this case, occupational and physical therapy was administered with botulinum therapy. Together, they successfully reduced pain. Botulinum therapy provides analgesia and muscle relaxation and may lead to functional recovery, and we believe that treatment can be considered even in the acute phase.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"9 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140841084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and psychometric properties of appraisals of post traumatic spinal cord injury health scale in Iran","authors":"Maryam Shabany, Vafa Rahimi-Movaghar, Roya Habibi Arejan, Reza Tabrizi, Parastoo Saberi, Vali Baigi, Zahra Ghodsi, Fatemeh Rakhshani, Morteza Gholami, Alexander R. Vaccaro, Seyed Mohammad Ghodsi","doi":"10.1038/s41394-024-00638-1","DOIUrl":"https://doi.org/10.1038/s41394-024-00638-1","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Study design</h3><p>Development and psychometrics study</p><h3 data-test=\"abstract-sub-heading\">Objective</h3><p>To evaluate the reliability and validity of a new version of Appraisals of Post-Traumatic Spinal Cord Injury Health Scale (APTSCIHS) in the Persian language for persons with spinal cord injury (SCI).</p><h3 data-test=\"abstract-sub-heading\">Setting</h3><p>The persons were selected from National Spinal Cord Injury Registry of Iran (NSCIR-IR) and Brain and Spinal Cord Injury Research center (BASIR).</p><h3 data-test=\"abstract-sub-heading\">Method</h3><p>This was a mixed sequential exploratory study that performed in two phases. In the qualitative phase, a systematic scoping review and 12 interviews with the participants were done. Finally, items were generated. In the quantitative phase, face, content, construct and convergent validity were assessed to evaluate validity. To evaluate construct validity, a cross-sectional study was conducted on 305 persons with TSCI along with internal consistency and stability assessments. All quantitative data analyses were conducted using SPSS 22 software.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The content validity and reliability were indicated by Scale’s Content Validity Ratio (S-CVR) = 0.73 and Scale’s Content Validity Index (S-CVI) = 0.86, Cronbach’s α = 0.9 and the Test re-test reliability using intra-class correlations were (ICC) = 0.97 to 0.98. Exploratory factor analysis determined eight factors which showed more than 52% of the variance. APTSCIHS had a significant and strong correlation with Appraisals of DisAbility Primary and Secondary Scale (ADAPSS) (r = 0.475, <i>P</i> &lt; 0.001).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Results showed the 36 items APTSCIHS tool had an acceptable validity and reliability in Iran, and it can help health care providers or even administrators improve the quality of the rehabilitation services and quality of life.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"147 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140801475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating the challenges of air travel in the United States: a qualitative study of the lived experiences of wheelchair users with spinal cord injury or disorder","authors":"Julie L. Pfeiffer, Walt Bower, Phillip Rumrill","doi":"10.1038/s41394-024-00641-6","DOIUrl":"https://doi.org/10.1038/s41394-024-00641-6","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Study design</h3><p>Qualitative exploratory study.</p><h3 data-test=\"abstract-sub-heading\">Objectives</h3><p>To understand the lived experiences of individuals with spinal cord injuries or disorders (SCI/D) who use wheelchairs during air travel in the United States (US), with a focus on the challenges and barriers to accessing this form of transportation.</p><h3 data-test=\"abstract-sub-heading\">Setting</h3><p>Wheelchair users with SCI/D living in the community in the US.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Semi-structured interviews were used to collect data from six wheelchair users with SCI/D. Data were analyzed using a six-step thematic analysis.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Experiences of wheelchair users during air travel clustered into three themes; experiences interacting with the airport, experiences interacting with the airplane, and experiences across all stages of air travel. Barriers to airport accessibility were minimal. Physical barriers to airplane accessibility and damage to wheelchairs occurred when interacting with the airplane and airline staff. Undertrained staff and a shift in responsibility to the passenger with a disability impacted all stages of the experience.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Wheelchair users with SCI/D encounter challenges that can result in unsafe and inaccessible air travel within the US. Adverse consequences of air travel often impact the individual’s independence and quality of life during and after the flight. Participants provided recommendations to improve the air travel experience for wheelchair users, including the ability to remain in one’s wheelchair while onboard the airplane.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"19 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140635279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed paraparesis after posterior spinal fusion for congenital scoliosis: a case report","authors":"Shuhei Ohtsubo, Masayuki Ohashi, Toru Hirano, Hideki Tashi, Tatsuo Makino, Keitaro Minato, Yusuke Mitsuma, Hiroyuki Deguchi, Rintaro Hoshino, Nobuko Ohashi, Kenta Furutani, Hiroyuki Kawashima, Kei Watanabe","doi":"10.1038/s41394-024-00639-0","DOIUrl":"https://doi.org/10.1038/s41394-024-00639-0","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>Although multimodal intraoperative neuromonitoring (IONM), which has high sensitivity and specificity, is typically performed during spinal deformity surgery, neurological status may deteriorate with delay after surgical maneuvers. Here, we report a rare case of delayed postoperative neurological deficit (DPND) that was not detected by IONM during posterior spinal fusion (PSF) for congenital scoliosis.</p><h3 data-test=\"abstract-sub-heading\">Case presentation</h3><p>A 14-year-old male presented with congenital scoliosis associated with T3 and T10 hemivertebrae. Preoperative Cobb angle of proximal thoracic (PT) and main thoracic (MT) curves were 50° and 41°, respectively. PSF (T1-L1) without hemivertebrectomy was performed, and the curves were corrected to 31° and 21° in the PT and MT curves, respectively, without any abnormal findings in IONM, blood pressure, or hemoglobin level. However, postoperative neurological examination revealed complete loss of motor function. A revision surgery, release of the curve correction by removing the rods, was immediately performed and muscle strength completely recovered on the first postoperative day. Five days postoperatively, PSF was achieved with less curve correction (36° in the PT curve and 26° in the MT curve), without postoperative neurological deficits.</p><h3 data-test=\"abstract-sub-heading\">Discussion</h3><p>Possible mechanisms of DPND in our patient are spinal cord ischemia due to spinal cord traction caused by scoliosis correction and spinal cord kinking by the pedicle at the concave side. Understanding the possible mechanisms of intra- and postoperative neural injury is essential for appropriate intervention in each situation. Additionally, IONM should be continued to at least skin closure to detect DPND observed in our patient.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":"302 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140609945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}