Late radiographic findings after the anterior cervical fusion for the cervical subaxial compressive flexion and vertical compression injuries in young patients

Objective. The aim of this study was to investigate the influence of patients’ age on the development of radiologic signs of degeneration of adjacent levels after the anterior fusion for the cervical spine injuries. Material and methods. A total of 45 patients who had compressive flexion and vertical compression injuries of the cervical spine (by Ferguson–Allen mechanistic classification) were included in the study. There were 40 male and 5 female patients with a mean age of 31.5 years (range 15–64). These patients were treated with anterior decompression, iliac bone grafting, and anterior plating. Twenty-two patients aged less than 30 years were in the first group; 23 individuals more than 30 years of age were in the second group. A long-term radiologic followup involved assessment of the fusion and examination of the changes at levels immediately above and below the fused vertebrae. Results. Hypermobility of the disc space above the fused vertebra was found in 9 (40.9%) patients from the first group vs. 3 (13%) from the second one (P<0.05). Narrowing and osteophytes of the disc space below the fused vertebra was found in 2 (9.1%) patients from the first group vs. 10 (43.5%) from the second one (P<0.05). Conclusions. Hypermobility of the motion segment above the fused vertebra was found more frequently in patients aged less than 30 years. Narrowing and osteophytes of the disc space below the fused vertebra were found more frequently in older patients

The bullet in the dural sac. How to catch it? A report of two cases

Objective. The purpose of this article is to present two cases of penetrating gunshot injuries to the lumbar spine with migration of the bullets within the dural sac and to describe the method of removal of the bullet from the dural sac. Material and methods. Two cases of penetrating gunshot injuries to the lumbar spine with migration of the bullets within the dural sac are presented. Clinical course, diagnostic tools, and management of two patients who suffered from these injuries are illustrated. The method of removal of the bullet from the dural sac is described too. Results. The wounds in these two cases healed without infection. The neurological status of our patients improved gradually. Radiographs taken 2 years after the injury did not demonstrate the postoperative instability of the lumbar spine. Conclusions. The bullet in the dural sac at the level of the cauda equina must be removed. The method proposed by us can facilitate this procedure

The measurements of health-related quality-of-life and pain assessment in the preoperative patients with low back pain

Objective. This prospective observational study of the Short-Form Health Survey (SF-36), Oswestry Disability Index, Lithuanian version of the McGill Pain Questionnaire, and Visual Analogue Scale (VAS) for pain was performed to evaluate their effectiveness in the additional preoperative screening of patients with disc herniation disease. Patients and methods. In the present study, we investigated a cohort of 100 patients with lumbar disc herniation causing low back pain and the second one of 100 patients with nonspecific low back pain by applying physical activity, pain scales and Short-Form 36 General Health Questionnaire. Results. The quantitative analysis of SF-36 domain scores showed the substantial differences in both examined (herniated and control) groups. In the present study, we estimated moderate but statistically significant (P<0.05) correlations between the bodily pain domain scores and assessment of back and leg pain on the VAS, as well as between the physical function and walking/standing ability (Oswestry). According to appropriate pain assessment instruments (Lithuanian version of the McGill Pain Questionnaire), qualitative and quantitative analysis of the preoperative patients was performed. Conclusion. The provided methodology could be used in population-based studies or in clinical samples that focus on specific impairments and seek to control the pain frequency and intensity, for example, follow-up assessments testing the effectiveness of surgical procedures performed, and to elicit the pathways leading to other impairments

Pathophysiology of acute spinal cord injury

Spinal cord injury is one of the most devastating of all traumatic conditions that can be encountered by patients. Over the past years much research has been performed on elucidating the mechanisms of spinal cord injury. Experimental and clinical studies have suggested that acute spinal cord injury is a twostep process involving primary and secondary mechanisms. Primary injury of the spinal cord refers to the initial mechanical damage due to local deformation of the spine. Direct compression and damage of neural elements and blood vessels by fractured and displaced bone fragments or disc material occur after mechanical trauma. The secondary mechanism is initiated by the primary injury. The secondary mechanism includes a cascade of biochemical and cellular processes, such as electrolyte abnormalities, formation free radicals, vascular ischemia, edema, posttraumatic inflammatory reaction, apoptosis or genetically programmed cell death and another processes. This review describes the pathophysiology of acute spinal cord injury. Knowledge of the pathophysiology of the acute spinal cord injury is crucial for successful management of the patients with these injuries

Upper cervical spine injuries and their diagnostic features

The upper cervical spine includes the articulations of the occiput with atlas and the atlas with the axis, as well as the bony structures of the base of the skull, axis, and atlas. The unique anatomy of the upper cervical spine and the typical mechanisms of injury yield a predictable variety of injury patterns. Injuries to this area include occipital condyle fractures, occipitoatlantal dislocations, subluxations and dislocations of the atlantoaxial articulation, atlas fractures, odontoid fractures, and fractures of the arch of the axis. Injuries to this region are relatively common and can be easily overlooked because patients with the upper cervical injury may have an associated head injury, which can alter their level of consciousness and complicate obtaining an accurate history and physical examination. The complex regional anatomy and overlying structures make plain radiographic images difficult to interpret. Delayed recognition can result in significant disability. A thorough understanding of the clinical presentation, radiographic assessment, and mechanisms of injury can minimize morbidity and enhance treatment effectiveness for the more common upper cervical ligamentous and bony injuries

Gerokai pasislinkusių kaklo antrojo slankstelio danties lūžių gydymo ypatybės

Objective. The purpose of this study was to determine the treatment features of odontoid fractures with a significant displacement. Material and methods. Thirty-seven patients with acute odontoid fractures were treated in Kaunas University of Medicine Hospital between 1998 and 2003. Seventeen persons with displacement of fragments less than 5 mm or 5 mm (according to E. A. Seybold and J. C. Bayley method) were in the first group. Twenty patients with displacement of fragments more than 5 mm were in the second group. The attempt of closed reduction of the cervical spine axis was performed for all patients. If successful closed reduction was achieved, patients were placed in halo-vest device for 8 weeks. If closed reduction failed, patient was operated according to W. E. Gallie. Postoperatively, all patients wore a halo-vest device during the first 8 weeks. Results. Demographics including age, sex, neurological condition, and associated spinal fractures were similar in patients from these groups (p>0.05). Successful closed reduction of the cervical spine axis was achieved in 11 (64.7%) patients from the first group and in 13 (65%) patients from the second group (p>0.05). Six (35.3%) patients from the first group and seven (35%) from the second group were treated with immediate C1–C2 posterior fusion (p>0.05). Two (16.7%) from twelve patients from the second group were treated by external immobilization by halo-vest device and had nonunion of fracture 8 weeks after the treatment. All operated patients had a solid fusion. Conclusions. If closed reduction of the odontoid fracture with a significant displacement was achieved then external immobilization by halo-vest device can be used [...]