Evaluation of the Results of Cervical Spine & Spinal Cord Trauma in Children

ObjectivesMajor differences exist in the anatomy and biomechanics of the growing spine that causes failure patterns different from those in adults. Spinal injury in the pediatric patient is a main concern because timely diagnosis and appropriate treatment can prevent further neurologic damage and deformity and potentiate recovery. We conducted a retrospective clinical study of 137 cases (93 boys, 44 girls) of pediatric cervical spine injuries, managed over fifteen years, to present data from a large series of pediatric patients with cervical spine injuries from a single regional trauma center. The aim was to assess and analyze complications, etiology, pathogenesis, site of injuries and age difference of cervical spine and spinal cord injury in a pediatric age group and compare the findings with current literature.Materials & MethodsOne hundred and thirty seven children with cervical spine injuries, seen over twelve years, were divided into two age groups: 54 patients were in group one (0-9 years ) and 83 patients were in group two (10 - 17 years) . We managed them according to status at presentation and type of injury. Forty seven patients were managed surgically and ninety nonsurgically (52 wore a halo brace and 38 wore different hard collars and braces). T-test and Chi squares were used to analyze differences between groupsResultsThe most common cause of injury was motor vehicle accidents(MVA). Our younger patients (Group 1) had sustained more neurological injuries than the older ones (Group 2), 77% vs.48%.; upper cervical spine was the most common site involved in 76%, while 43% suffered head injuries. In group two, 88% of children two sustained fractures or fracture/ subluxations; also in this group, subluxation, and fracture/ subluxation was present in 10 and 25% of children respectively. The most common radiological findings were vertebral fractures (38%). Solid fusions were demonstrated in all patients at late follow-up review (mean 6 years). None of the children developed neurological deterioration; however 18% mortality was documented. Various fusion techniques were used and neurological and fusion outcomes improved as compared with the previous reports.ConclusionOutcomes of cervical spine injuries in children are more positive than in adults, particularly in patients with incomplete injuries. The prognosis for children with complete spinal cord injuries, however, is still discouraging. Upper cervical spine injuries are more common between birth and 9 years of age; however fractures and fracture/subluxation are rare in this group. Surgical intervention with appropriate instrumentation and fusion are very effective in children with cervical spine instability.

National guidelines for cognitive assessment and rehabilitation of Iranian traumatic brain injury patients

Background: Individuals with moderate to severe traumatic brain injury (TBI) often have prolonged cognitive impairments, resulting in long-term problems with their real-life activities. Given the urgent need for evidence-based recommendations for neuropsychological management of Iranian TBI patients, the current work aimed to adapt eligible international guidelines for cognitive assessment and rehabilitation of the TBI patients in Iran. Methods: The project was led by an executive committee, under the supervision of the Iranian Ministry of Health and Medical Education (MOHME). Following a systematic literature search and selection process, four guidelines were included for adaptation. Clinical recommendations of the source guidelines were tabulated as possible clinical scenarios for 90 PICO clinical questions covering all relevant phases of care. After summing up the scenarios, our initial list of recommendations was drafted according to the Iranian patients� conditions. The final decision-making, with the contribution of a national interdisciplinary panel of 37 experts from across the country, was conducted in two rounds using online and offline survey forms (Round 1), and face-to-face and telephone meetings (Round 2). Results: A total of 63 recommendations in six sections were included in the final list of recommendations, among which 24 were considered as key recommendations. In addition, some of the recommendations were identified as fundamental, meaning that proper implementation of the other recommendations is largely dependent on their implementation. Conclusion: Iranian health policy makers and rehabilitation program managers are recommended to address some fundamental issues to provide the necessary infrastructure to set up an efficient cognitive rehabilitation service system. © 2020 Academy of Medical Sciences of I.R. Iran. All rights reserved

Evaluation Of The Results Of Surgical And Medicaltreatment In 16 Patients With Vertigo Secondary Tocervical Spondylosis

Background: In patients with cervical spondylosis, cord compression and impingement of cord vessels as well as the vertebral artery may be accompanied by vertigo. We evaluated improvement of vertigo in these patients after surgical and medical treatment. Methods: In this prospective study we reviewed 16 patients with vertigo suspected of cervical spondylosis, admitted to our hospital between 1999 and 2004. Before orthopedic examination, other causes of vertigo related to the field of ENT and neurologic problems had been ruled out. Dynamic angiography and /or Doppler sonography were performed in patients during flexion and extension and rotation of the cervical spine. Operations such as laminectomy and foraminotomy and resection of osteophytes were performed in patients who did not improve by conservative treatment. Results: There were ten males and six females, with a mean age of 62.5 years. Twelve patients had cervical canal stenosis, and four patients also had vertebral artery stenosis. In two patients angioplasty of the vertebral artery was performed. Operations were performed in twelve patients and conservative treatment was used in four patients. Surgical treatment gave good relief of symptoms and was satisfactory in eight patients and not satisfactory in four patients. Conservative treatment improved symptoms in one patient, and was not satisfactory in three patients (p <.05). Conclusion: Vertigo occurs in patients with cervical spondylosis, especially in old patients with spondylosis. In most cases we had improvement of vertigo by surgical decompression of the cervical cord and arteries

Evaluation of The Results of Surgical and Medical Treatment In 16 Patients With Vertigo Secondary to Cervical Spondylosis

Background:In patients with cervical spondylosis,cord compression and impingement of cord vessels as well as the vertebral artery may be accompanied by vertigo.We evaluated improvement of vertigo in these patients after surgical and medical treatment.Methods:In this prospective study we reviewed 16 patients with vertigo suspected of cervical spondylosis,admitted to our hospital between 1999 and 2004. Before orthopedic examination,other causes of vertigo related to the field of ENT and neurologic problems had been ruled out.Dynamic angiography and /or Doppler sonography were performed in patients during flexion and extension and rotation of the cervical spine. Operations such as laminectomy and foraminotomy and resection of osteophytes were performed in patients who did not improve by conservative treatment. Results: There were ten males and six females, with a mean age of 62.5 years. Twelve patients had cervical canal stenosis, and four patients also had vertebral artery stenosis. In two patients angioplasty of the vertebral artery was performed. Operations were performed in twelve patients and conservative treatment was used in four patients.Surgical treatment gave good relief of symptoms and was satisfactory in eight patients and not satisfactory in four patients.Conservative treatment improved symptoms in one patient,and was not satisfactory in three patients (p <.05).Conclusion:Vertigo occurs in patients with cervical spondylosis,especially in old patients with spondylosis.In most cases we had improvement of vertigo by surgical decompression of the cervical cord and arteries