No abstract available.
Autonomic Dysreflexia* ; Humans ; Manometry* ; Spinal Cord Injuries*

PURPOSE: The purpose of this study was to determine the direction for treatment and to evaluate factors influencing improvement by comparison of neurologic and functional outcomes of surgical treatment and conservative treatment for traumatic central cord syndrome. MATERIALS AND METHODS: A total of 28 patients, who were available for follow-up for at least more than one year from January 2005 to December 2008, who were diagnosed as traumatic central cord syndrome were analyzed retrospectively. Fifteen patients underwent surgical treatment (group 1), and 13 patients received conservative treatment (group 2). Maximum canal compromise (MCC), and maximum spinal cord compression (MSCC) were used for radiologic assessment, and American Spinal Injury Association (ASIA) motor score, Japanese Orthopaedic Association (JOA) score, and neck disability index (NDI) were used for assessment of functional outcomes. RESULTS: The mean MCC was 47.2%, mean MSCC was 20.0%, and mean ASIA motor scale was 92.0 (group 1: 92.9, group 2: 90.9) at the final follow-up. The mean JOA score was 12.8 (group 1: 14.0, group 2: 11.4) and mean NDI was 25.0 (group 1: 25.7, group 2: 24.3) at the final follow-up. CONCLUSION: It is concluded that if a patient with traumatic central cord syndrome is young, with a high energy injury combined with fractures, and has severe spinal compression and mild initial neurologic defect, early surgical treatment would be needed as soon as possible.
Asia ; Asian Continental Ancestry Group ; Central Cord Syndrome* ; Follow-Up Studies ; Humans ; Neck ; Retrospective Studies ; Spinal Cord Compression ; Spinal Cord Injuries ; Spinal Injuries ; Treatment Outcome

Allodynia is pain following a non-noxious stimuli which does not provoke pain normally and develops after incomplete spinal cord injury more commonly in cervical rather than thoracic level, and central cord syndrome. This article presents an unusual patient who presented with the single symptom of an intense allodynia after cervical intervertebral disc herniation. This 36-year-old male patient developed acute lancinating and burning pain aggravated by skimming light touch on both thenar area. Cervical magnetic resonance imaging (MRI) revealed central disc herniation and spinal cord compression. The allodynia secondary to acute herniated cervical disk has been successfully disappeared through pharmacotherapy with pulsed-use of steroid, gabapentin and comprehensive rehabilitation.
Adult ; Amines ; Burns ; Central Cord Syndrome ; Cyclohexanecarboxylic Acids ; gamma-Aminobutyric Acid ; Humans ; Hyperalgesia ; Intervertebral Disc ; Light ; Magnetic Resonance Imaging ; Male ; Spinal Cord Compression ; Spinal Cord Injuries

PURPOSE: We designed this study to evaluate the incidence of spinal cord injury and the results of surgical treatment of lower cervical spine injury, and to suggest a rational treatment guideline according to the stages of Allen's mechanistic classification of the lower cervical spine injury. MATERIALS AND METHODS: We reviewed the medical records and roentgenograms of 66 patients (49 men and 17 women), who were treated surgically for acute fracture and dislocation of the lower cervical spine since March. 1991 to March. 1996. These patients ranged in age from 17 to 68 years (average age- 38 years). We used Allen's mechanistic classification to analyze fractures in the lower cervical spine injury. We divided neurologic status by complete, incomplete, root injury and no neurologic deficit group, Surgical treatment was performed for those with unstable fracture/dislocation, progressive neurologic deficit with conservative care, neurologic deficit with spinal cord compression by fracture fragment or extruded disc material. Surgical approach was determined according to the site of lesion. We analyzed the surgical treatment results according to neurologic recovery, radiologic bone union and complications, We used chisquare test for statistical analysis of neurologic improvement between the different surgical treatments. RESULTS: Twenty-nine cases were distractive-flexion (DF) phylogeny, 19 cases were compressive-flexion (CF), 2 cases were vertical-compression (VC), 8 cases were compressive-extension (CE), and 8 cases were distractive-extension (DE) phylogeny. For definitive surgical treatments we performed anterior cervical discectomy and fusion (ACDF) in 25, ACDF with anterior stabilizaiton in 30, posterior fusion in 5, and circumferential fusion in 6. There was no neurologic recovery in complete cord injury. There were 32 cases of incomplete cord injury all 8 anterior cord syndromes had no neurologic recovery, among 22 patients with central cord syndrome 18 had neurolgic recovery in various degrees and 2 with Brown-Seguard syndrome showed significant neurologic recovery. In nerve root injury, all patients had complete neurologic recovery. There was no radiologic nonunion at all and it took 10.3 weeks in average for radiologic bone union. There were neurogenic bladder, bed sore, local kyphosis, duodenal ulcer, respiratory infection, persistent neck pain and superficial wound infection in complications. Summary and CONCLUSIONS: In extension (CE, DE) injuries with neurologic deficit, anterior approach should be recommended because the major pathology is located in the anterior structure of the cervical spine. In flexion (DF and CF) injuries with major posterior osteoligamentous disruption, posterior approach could fix the posterior structures. Anterior decompression and fusion should be followed whenever anterior pathology is compressing the spinal cord or nerve root. Posterior open reduction and fusion is necessary whenever there is unreduced facet joint dislocation with or with out neurologic deficit. To prevent the late local kyphosis and persistent neurologic deficit with neck pain after prolonged external immobilization with ACDF, anterior stabilization with a plate and screw system is necessary to augment the surgical treatment of the unstable lower cervical spine injury which necessitates anterior decompression.
Central Cord Syndrome ; Classification ; Decompression ; Diskectomy ; Dislocations ; Duodenal Ulcer ; Humans ; Immobilization ; Incidence ; Kyphosis ; Male ; Medical Records ; Neck Pain ; Neurologic Manifestations ; Pathology ; Phylogeny ; Pressure Ulcer ; Spinal Cord ; Spinal Cord Compression ; Spinal Cord Injuries ; Spine* ; Urinary Bladder, Neurogenic ; Wound Infection ; Zygapophyseal Joint

Adult ; Autonomic Dysreflexia ; therapy ; Cesarean Section ; Female ; Humans ; Pregnancy ; Pregnancy Complications ; therapy ; Spinal Cord Injuries ; complications

We tried subcutaneous physostigmine 31 times in 24 spinal cord injured patients who had lost ejaculatory capacity. Normal semens were obtained in 4 patients(6.7 %), subnormal semen in 1 patient(4.2 %), a few sperms in 5 patients(20.8 %), and no sperm in 14 patients(58.3%). Sperm appearance rate was 41.7%. Patients with injuries in cervical and upper thoracic levels ejaculated successfully mere frequently than those with injuries in lower thoracic and lumbar levels. The results or T, L1, L2 injured patients were not successful. Side effects included nausea and vomiting (91.7%), dizziness(45.8%) and headache(25.0%), but all patients could tolerate them. Significant adverse effects, particularly autonomic dysreflexia, were not found. Artificial uterine inseminations with sperms induced by subcutaneous physostigmine were performed in 3 cases, and all of these attempts were successful. We have 3 live births. In conclusion, subcutaneous physostigmine for provoking ejaculation in anejaculatory spinal cord injury is cheap, easy to be performed and has no significant side effect.
Autonomic Dysreflexia ; Ejaculation* ; Humans ; Insemination ; Live Birth ; Male ; Nausea ; Physostigmine* ; Semen ; Spermatozoa ; Spinal Cord Injuries* ; Spinal Cord* ; Vomiting

PURPOSE: Autonomic dysreflexia represents one of the most serious medical emergencies in the care and rehabilitation of patients with spinal cord injury. We evaluated the effect of terazosin for the prevention of symptoms due to autonomic dysreflexia in patients with spinal cord injury. MATERIALS AND METHODS: The effect of terazosin was evaluated in 20 spinal cord injury patients with autonomic dysreflexia. All patients received terazosin as the only medication for the autonomic dysreflexia. Baseline measurements of blood pressure, the autonomic dysreflexia severity score and autonomic dysreflexia frequency score were recorded before terazoxin medication. Follow-up measurements were taken at 1 week, 1 month and 3 month after medication. All the data were statistically evaluated and the following results were obtained. RESULTS: The majority of patients(95%) had manifested headache and sweating. The autonomic dysreflexia severity score after terazosin medication decreased from an average of 9.0+/-0.6 at baseline to 6.8+/-0.7, 5.2+/-0.7 and 4.9+/-0.6 at 1 week, 1 month and 3 months repectively(p=0.001). And the autonomic dysreflexia frequency score after terazosin medication decreased from an average of 2.4+/-0.5 to 1.2+/-0.4 at 3 months. CONCLUSION: Tetazosin appears to be effective in preventing symptoms due to autonomic dysreflexia.
Autonomic Dysreflexia ; Blood Pressure ; Emergencies ; Follow-Up Studies ; Headache ; Humans ; Rehabilitation ; Spinal Cord Injuries* ; Spinal Cord* ; Sweat ; Sweating

Effective rehabilitation and assisted reproductive technology may increase the number of women considering pregnancy who have spinal cord injuries. It is important that obstetricians caring for these patients are aware of the specific problems related to spinal cord injuries. Autonomic dysreflexia is the most significant medical complication found in women with spinal cord injuries, and precautions should be taken to avoid stimuli that can lead to this potentially fatal complication. Women with spinal cord injuries may give birth vaginally, but when cesarean delivery is indicated, adequate anesthesia is needed. We report three cases of delivery in patients with spinal cord injury.
Anesthesia ; Autonomic Dysreflexia ; Female ; Humans ; Parturition ; Pregnancy ; Pregnant Women ; Reproductive Techniques, Assisted ; Spinal Cord ; Spinal Cord Injuries

Autonomic dysreflexia is a syndrome of uninhibited sympathetic spinal reflexes in response to stimuli below the level of injury in the patients with high spinal lesions. During labor, it can cause uteroplacental vasoconstriction resulting in fetal distress or devastating maternal complications including retinal hemorrhage, cerebrovascular accident and hypertensive encephalopathy. Neuraxial blockade has proven to be an effective method to attenuate or prevent it. We present a case detailing the use of epidural analgesia in managing the delivery of a quadriplegic parturient with a history of autonomic dysreflexia.
Analgesia, Epidural* ; Autonomic Dysreflexia ; Fetal Distress ; Humans ; Hypertensive Encephalopathy ; Reflex ; Retinal Hemorrhage ; Spinal Cord Injuries* ; Spinal Cord* ; Stroke ; Vasoconstriction

OBJECTIVE: To describe the frequency and reasons for rehospitalization in patients with spinal cord injury (SCI) living in the community. METHOD: A total 388 patients with SCI living in community participated in the nationwide questionnaire-based study. A self-administered questionnaire was used. RESULTS: Of the 459 patients originally enrolled, 388 completed questionnaires, yielding response rate of 84.5%. The reasons for rehospitalization were SCI related complications (71.7%), periodic health evaluation (44.7%), and other causes (28.3%). The most frequent SCI related complications for rehospitalization were urinary tract infections (45.2%), pressure sores (39.7%), fever (18.3%), pain (18.3%), and autonomic dysreflexia (7.6%). The number of rehospitalized cases due to SCI related complication including urinary tract infection was significantly higher in complete SCI. Rehospitalization due to pressures sore was more frequent in people with paraplegia, male and complete injuries. CONCLUSION: In our study, 71.7% of patients with SCI experienced rehospitalization for SCI related complication after initial hospitalization. Urinary tract infection and pressure sores were the most common SCI related complications for rehospitalization.
Autonomic Dysreflexia ; Fever ; Hospitalization ; Humans ; Male ; Paraplegia ; Pressure Ulcer ; Surveys and Questionnaires ; Spinal Cord ; Spinal Cord Injuries ; Urinary Tract Infections