Observations in the diagnosis of cervical myelopathy in patients suffering from diabetes mellitus.
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Observations in the diagnosis of cervical myelopathy in patients suffering from diabetes mellitus.
Spinal Cord. 2012 Dec;50(12):878-81
Authors: Okada M, Minamide A, Yoshida M, Kawakami M, Enyo Y, Endo T
Abstract
OBJECTIVES: To identify any observations that could aid in the diagnosis of cervical myelopathy in patients suffering from diabetes mellitus (DM). We compared the preoperative neurological findings in patients with cervical myelopathy among non-diabetics, mild diabetics and severe diabetics.
STUDY DESIGN: A retrospective comparative study.
SETTING: Department of Orthopaedic Surgery, Wakayama Medical University, Japan.
METHODS: We retrospectively reviewed 111 patients who had undergone laminoplasty for cervical compressive myelopathy: 56 without DM and 29 with severe diabetes more than 10 years of medication; more than 7.0% HbA1c; diabetic retinopathy; and delayed conduction velocity of peripheral nerves. For preoperative neurological assessment we compared the following among the three groups: the 10?s test whereby the myelopathy in the hand was quantified; sensory disturbance; deep tendon reflexes; Hoffmann's, Trömner's and Babinski's reflexes; and bladder dysfunction.
RESULTS: There was no significant difference preoperatively in the 10?s test between the groups. Deep tendon reflexes were significantly decreased in group S. There were no significant differences in sensory disturbance and bladder dysfunction. Although Hoffmann's and Trömner's reflexes significantly disappeared in group S, there was no significant difference in positivity of Babinski's reflex between the groups.
CONCLUSIONS: The 10?s test and Babinski's reflex are helpful for the diagnosis of cervical myelopathy in patients suffering from DM.
PMID: 22584286 [PubMed - indexed for MEDLINE]
Anterior decompression and nonstructural bone grafting and posterior fixation for cervical facet dislocation with traumatic disc herniation.
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Anterior decompression and nonstructural bone grafting and posterior fixation for cervical facet dislocation with traumatic disc herniation.
Spine (Phila Pa 1976). 2012 Dec 1;37(25):2082-8
Authors: Feng G, Hong Y, Li L, Liu H, Pei F, Song Y, Huang F, Tu C, Li T, Gong Q, Liu L, Zeng J, Kong Q, Gupte M
Abstract
STUDY DESIGN: A series study of patients with lower cervical facet dislocation accompanied by traumatic disc herniation treated with anterior decompression and nonstructural bone grafting and posterior fixation.
OBJECTIVE: To describe a surgical technique of anterior decompression and nonstructural bone grafting and posterior fixation and its clinical outcome in a group of patients with lower cervical facet dislocation accompanied by traumatic disc herniation.
SUMMARY OF BACKGROUND DATA: The optimal treatment for lower cervical facet dislocation with a prolapsed disc is still controversial.
METHODS: After discectomy and endplate preparation, a layer of morselized cancellous bone grafts from the iliac crest was placed in the interspace, and held in appropriate sagittal position by 2 layers of gelatin sponge and carefully sutured longus colli muscle. The anterior wound was then closed. The posterior elements were exposed and the reduction was performed. Fluoroscopy was used during reduction maneuver to ensure that the graft was still in the appropriate position. A posterior fusion was performed and the posterior wound was closed.
RESULTS: Between January 2006 and February 2010, 21 patients with cervical facet dislocation accompanied by traumatic disc herniation (13 unilateral dislocations and 8 bilateral dislocations) were recruited for this study. All the patients completed at least 1-year follow-up. Average follow-up duration was 29 ± 3.5 months. Average Frankel scales were significantly improved at the end of follow-up, visual analogue scale decreased from 7.8 ± 1.2 before the operation to less than 1.6 ± 0.5 (P < 0.05) 6 months later. Kyposis was corrected from 17.7° ± 6.3° to 6.5° ± 4.1° (P < 0.05) and remained at 5.9° ± 4.2° (P > 0.05) 1 year later. The average subsidence of bone graft was 1.28 ± 0.16 mm at 12 months after the operation and remained 1.34 ± 0.20 mm at 36 months after the operation. All patients had consolidation of both anterior and posterior fusions. No cases of instrument failure occurred and no complications were attributed to the use of this technique.
CONCLUSION: Although further study based on injury types as well as long-term follow-up is still needed, anterior decompression and nonstructural bone grafting and posterior fixation provides a promising surgical option for treating cervical facet dislocation with traumatic disc herniation.
PMID: 22614801 [PubMed - indexed for MEDLINE]
Editorial Note on: Observations in the diagnosis of cervical myelopathy in patients suffering from diabetes mellitus.
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Editorial Note on: Observations in the diagnosis of cervical myelopathy in patients suffering from diabetes mellitus.
Spinal Cord. 2012 Dec;50(12):881
Authors: Hagen EM
PMID: 22665220 [PubMed - indexed for MEDLINE]
Long-term evaluation of phrenic nerve pacing for respiratory failure due to high cervical spinal cord injury.
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Long-term evaluation of phrenic nerve pacing for respiratory failure due to high cervical spinal cord injury.
Spinal Cord. 2012 Dec;50(12):895-8
Authors: Romero FJ, Gambarrutta C, Garcia-Forcada A, Marín MA, Diaz de la Lastra E, Paz F, Fernandez-Dorado MT, Mazaira J
Abstract
OBJECTIVES: Phrenic nerve pacing is a method of respiratory support that can replace mechanical ventilation in high-level cervical spinal cord injury patients with diaphragmatic paralysis. Our objective was to evaluate survival and long-term quality of life in patients with external respiratory support by PNP vs volumetric respirator in patients with severe respiratory insufficiency due to a high-level spinal cord injury.
DESIGN: This is a retrospective review study of a prospectively collected database for evaluate the survival and a questionnaire for quality of life has been collected face-to-face or by telephone at present.
PATIENTS: Cervical SCI patients with permanent respiratory support (PNP or MV).
METHODS: Long-term evaluation of a cohort of PNP-supported patients. We performed a comparison between these patients and volumetric respirator-supported patients. For survival analysis, we used the Kaplan-Meier method and Cox proportional hazards model. The health-related quality of life was assessed with SF-36 questionnaire, a general HRQL evaluation.
RESULTS: One hundred twenty six patients on permanent respiratory support were evaluated during the study period. Of these, 38 were on PNP and 88 were mechanically ventilated. Paced patients were younger and had a longer survival, but in a multivariate analysis adjusted for age using a multiple logistic correlation we found that length of survival was greater for PNP patients. In terms of HRQL, the PNP-supported patients showed better results in terms of social functioning.
CONCLUSIONS: PNP is a stable and effective method of long-term respiratory support in this type of patients (SCI patients dependent on external respiratory support). In these patients it improves the length of survival and some social issues by quality of life when compared with patients under MV.
PMID: 22777487 [PubMed - indexed for MEDLINE]
Expectations of benefit and tolerance to risk of individuals with spinal cord injury regarding potential participation in clinical trials.
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Expectations of benefit and tolerance to risk of individuals with spinal cord injury regarding potential participation in clinical trials.
J Neurotrauma. 2012 Dec 10;29(18):2727-37
Authors: Kwon BK, Ghag A, Dvorak MF, Tetzlaff W, Illes J
Abstract
We conducted a survey of individuals living with spinal cord injury (SCI) to determine their receptivity to participating in clinical trials of drug therapies or stem cell therapies, their anticipation of therapeutic benefits, and their tolerance to risk. A 46-item questionnaire was administered to individuals with cervical or thoracic SCI identified through a provincial database. The average age was 42 years and the individuals were, on average, 5.5 years post-injury. Receptivity to neuroprotective drug trials in the acute setting was very high, but somewhat less so for stem cell trials in the subacute or chronic (current) setting. With respect to expectation of functional benefit, approximately one third of the respondents indicated that they would want a 5-25% chance of achieving some functional recovery if enrolling in a stem cell therapy clinical trial in the current, chronic injury state. Whereas the majority typically would require the risk of spinal cord damage, cancer, infection, and nerve pain from invasive cell transplantation trials to be ?1%, 15-30% would participate regardless of the risk of these complications. The factors associated with this high risk tolerance were gender (males>females), age (elderly>young), and self-reported knowledge of SCI research (greater knowledge>less knowledge). Injury severity or chronicity did not have a significant correlation with risk tolerance. Whereas previous studies have shown that the understanding of stem cell science is limited among individuals with SCI, here we show that many still have high hopes for the possibility of neurological benefit, are anxious to participate in invasive stem cell trials, and, in many cases, have high tolerance for risk in such trials. Taken together, the data underscore the need for careful communication with individuals with SCI to avoid unrealistic expectations and therapeutic misconception in experimental trials.
PMID: 22924691 [PubMed - indexed for MEDLINE]
Soft-tissue damage and segmental instability in adult patients with cervical spinal cord injury without major bone injury.
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Soft-tissue damage and segmental instability in adult patients with cervical spinal cord injury without major bone injury.
Spine (Phila Pa 1976). 2012 Dec 1;37(25):E1560-6
Authors: Maeda T, Ueta T, Mori E, Yugue I, Kawano O, Takao T, Sakai H, Okada S, Shiba K
Abstract
STUDY DESIGN: A retrospective imaging and clinical study.
OBJECTIVE: To evaluate the extraneural soft-tissue damage and its clinical relevance in patients with traumatic cervical spinal cord injury (SCI) without major bone injury.
SUMMARY OF BACKGROUND DATA: To date, various kinds of cervical discoligamentous injuries have been demonstrated on magnetic resonance images in patients with SCI without bony injury. However, it has not been clear whether these magnetic resonance imaging abnormalities are actually related to spinal segmental instability and the patients' neurological status.
METHODS: Eighty-eight adult patients with acute traumatic cervical SCI without major bone injury were examined by flexion-extension lateral radiographs and magnetic resonance images within 2 days after trauma. We excluded patients with flexion recoil injury; therefore, most of the patients included were considered to have sustained a hyperextension injury. Instability of the injured cervical segment was defined when there was more than 3.5-mm posterior translation and/or more than a 11° difference in the intervertebral angle between the site of interest and adjacent segments. The neurological status was evaluated according to the American Spinal Injury Association motor score.
RESULTS: On magnetic resonance images, the damage to the anterior longitudinal ligament and intervertebral disc were apparent in 44 and 37 patients, respectively. Various degrees of prevertebral fluid collection (prevertebral hyperintensity) were demonstrated in 76 patients. These magnetic resonance imaging abnormalities were significantly associated with initial cervical segmental instability as judged by flexion-extension radiographs. Interestingly, the American Spinal Injury Association motor score had a significant association with either magnetic resonance imaging abnormalities or segmental instability but not with the cervical canal diameter.
CONCLUSION: A considerable proportion of the patients with traumatic cervical SCI without major bone injury were shown to have various types of soft-tissue damage associated with cervical segmental instability at the early stages of the injury. The severity of paralysis greatly depended on these discoligamentous injuries.
PMID: 22972511 [PubMed - indexed for MEDLINE]
Cervical chordoma with moderate bone impairment in a child. Answer to October E-quid.
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Cervical chordoma with moderate bone impairment in a child. Answer to October E-quid.
Diagn Interv Imaging. 2012 Nov;93(11):903-6
Authors: Guillonnet A, Bengolea L, Funes J, Velán O, Mónaco RG, Besada C
PMID: 23146827 [PubMed - indexed for MEDLINE]
Degeneration of phrenic motor neurons induces long-term diaphragm deficits following mid-cervical spinal contusion in mice.
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Degeneration of phrenic motor neurons induces long-term diaphragm deficits following mid-cervical spinal contusion in mice.
J Neurotrauma. 2012 Dec 10;29(18):2748-60
Authors: Nicaise C, Putatunda R, Hala TJ, Regan KA, Frank DM, Brion JP, Leroy K, Pochet R, Wright MC, Lepore AC
Abstract
A primary cause of morbidity and mortality following cervical spinal cord injury (SCI) is respiratory compromise, regardless of the level of trauma. In particular, SCI at mid-cervical regions targets degeneration of both descending bulbospinal respiratory axons and cell bodies of phrenic motor neurons, resulting in deficits in the function of the diaphragm, the primary muscle of inspiration. Contusion-type trauma to the cervical spinal cord is one of the most common forms of human SCI; however, few studies have evaluated mid-cervical contusion in animal models or characterized consequent histopathological and functional effects of degeneration of phrenic motor neuron-diaphragm circuitry. We have generated a mouse model of cervical contusion SCI that unilaterally targets both C4 and C5 levels, the location of the phrenic motor neuron pool, and have examined histological and functional outcomes for up to 6 weeks post-injury. We report that phrenic motor neuron loss in cervical spinal cord, phrenic nerve axonal degeneration, and denervation at diaphragm neuromuscular junctions (NMJ) resulted in compromised ipsilateral diaphragm function, as demonstrated by persistent reduction in diaphragm compound muscle action potential amplitudes following phrenic nerve stimulation and abnormalities in spontaneous diaphragm electromyography (EMG) recordings. This injury paradigm is reproducible, does not require ventilatory assistance, and provides proof-of-principle that generation of unilateral cervical contusion is a feasible strategy for modeling diaphragmatic/respiratory deficits in mice. This study and its accompanying analyses pave the way for using transgenic mouse technology to explore the function of specific genes in the pathophysiology of phrenic motor neuron degeneration and respiratory dysfunction following cervical SCI.
PMID: 23176637 [PubMed - indexed for MEDLINE]
Modern management of patellar instability.
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Modern management of patellar instability.
Int Orthop. 2012 Dec;36(12):2447-56
Authors: Rhee SJ, Pavlou G, Oakley J, Barlow D, Haddad F
Abstract
Recurrent patellofemoral instability is a disabling condition, attributed to a variety of anatomical aetiologies. Trochlear dysplasia, patella alta, an increased tibial tubercle trochlear groove distance of greater than 20 mm and soft tissue abnormalities such as a torn medial patellofemoral ligament and inadequate vastus medialis obliquus are all factors to be considered. Management of this condition remains difficult and controversial and knowledge of the functional anatomy and biomechanics of the patellofemoral joint, a detailed history and clinical examination, and an accurate patient assessment are all imperative to formulate an appropriate management plan. Surgical treatment is based on the underlying anatomical pathology with an aim to restore normal patellofemoral kinematics. We summarise aspects of assessment, treatment and outcome of patellofemoral instability and propose an algorithm of treatment.
PMID: 23052278 [PubMed - indexed for MEDLINE]
Potential predictors of changes in gross motor function during various tasks for children with cerebral palsy: a follow-up study.
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Potential predictors of changes in gross motor function during various tasks for children with cerebral palsy: a follow-up study.
Res Dev Disabil. 2013 Jan;34(1):721-8
Authors: Chen CL, Chen CY, Chen HC, Liu WY, Shen IH, Lin KC
Abstract
Very few studies have investigated predictors of change in various gross motor outcomes in ambulatory children with cerebral palsy (CP). The aim of this study was to identify potential predictors for change in gross motor outcomes measured during various tasks in children with CP. A group of 45 children (age, 6-15 years) with CP and 7 potential predictors were identified, including age, gender, CP subtypes, gross motor function classification system (GMFCS) levels, abdominal muscle endurance, and muscles strength of knee extensor and knee flexor measured by isokinetic dynanometer. Motor outcome was assessed by means of the gross motor composite (GMC) of Bruininks-Oseretsky Test of Motor Proficiency (BOTMP), including four gross motor subtests: running speed and agility (RSA), balance (BAL), bilateral coordination (BCO), and strength (STR). The outcomes were measured at baseline and 12-week later (follow-up). The regression analyses showed that knee extensor strength was a robust predictor of change in BAL, BCO, and GMC (adjusted R(2) = 0.07-0.19, P<0.05). Additionally, abdominal muscle strength was a negative predictor for the changes in the RSA (adjusted R(2) = 0.08, P<0.05). However, STR model revealed no significant predictors. These findings suggest that ambulatory children with greater knee muscle strength may benefit more from therapy than those with lower strength. The knee muscle strength can be used as a biomarker to predict the changes in the gross motor functions.
PMID: 23178177 [PubMed - indexed for MEDLINE]
D5 Creation