Management of cervical spinal cord trauma.

Trauma victims with cervical spinal cord injuries should be managed by proper immobilization and immediate reduction of spinal cord fractures to anatomical alignment. Patients must be stabilized medically, and a thorough neurologic and radiographic evaluation must precede any surgical intervention. Treatment must be individualized and depends on the level and severity of injury.

Reoperation of the cervical spine for degenerative disease and tumor.

Despite improvements in treatment for cervical spine disease over the last decade, failure that requires a reoperative procedure may represent up to 14% of the cases. With the exception of posterior foraminotomy, the most common failure that requires intervention is instability, which results in an anterior compression of the neural elements. With the advent of new operative approaches and innovative stabilization techniques, the options available to treat these patients have improved.

Decussation of hind-limb and fore-limb fibers in the monkey corticospinal tract: relevance to cruciate paralysis.

Cruciate paralysis is a clinical entity in which patients with trauma to the anterior cervicomedullary junction present with weakness of the upper extremity greater than that of the lower extremity. The underlying mechanism of this paralysis is commonly thought to be selective damage affecting the upper-extremity nerve fibers in the pyramidal decussation. The authors examined the anatomical basis of cruciate paralysis in six New World squirrel monkeys and two Old World cynomolgus monkeys.

Management of athletic injuries of the cervical spine and spinal cord.

Injuries to the cervical spine among athletes present inherent difficulties, especially in advising for return to contact sports. Experience with the acute care of 63 patients who sustained cervical spine injuries while participating in organized sporting events is analyzed. Forty-five patients had permanent injury to the vertebral column and/or spinal cord, while 18 suffered only transient spinal cord symptoms.

Pediatric spinal cord injury without radiographic abnormalities: report of 26 cases and review of the literature.

Spinal cord injury without radiographic abnormality (SCIWORA) occurs primarily in the pediatric population but is less common than other forms of spinal injury among children. Between 1972 and 1990, 159 pediatric patients were admitted to the Barrow Neurological Institute with acute traumatic spinal cord or vertebral column injuries. Of these, 26 children (16%) sustained SCIWORA.

Magnetic resonance imaging of the transverse atlantal ligament for the evaluation of atlantoaxial instability.

Twenty normal human subjects and 14 patients with upper cervical spine pathology were studied with axial high-field magnetic resonance (MR) imaging to examine the transverse atlantal ligament. Gradient-echo MR imaging pulse sequences provided reliable visualization of the transverse ligament, which exhibited low signal intensity and extended behind the dens between the medial portions of the lateral masses of C-1. The MR imaging characteristics of the transverse ligament were verified in clinical studies and in postmortem specimens.

Diving accidents. Mechanism of injury and treatment of the patient.

Diving accidents that result in cervical spinal injuries most often occur in young adult males who have access to alcohol and water. A C-5 injury with permanent neurologic deficit is the most common pattern of injury in these patients. Recommended treatments include emergent alignment, an intravenous bolus of methylprednisolone, and spinal stabilization.

Traumatic atlantooccipital dislocation with survival.

Survival after traumatic atlantooccipital dislocation is rare. Only long-term survivors have been reported in the literature; however, improved prehospital care is likely responsible for the increase in the number of these patients seen at neurotrauma centers over the last decade. Associated severe and persistent neurological deficits are common in the few survivors.

The interspinous method of posterior atlantoaxial arthrodesis.

Thirty-six patients underwent C1-2 posterior wiring and fusion procedures over a 5-year period for unstable C-2 fractures (eight cases), unstable atlas-axis combination fractures (six cases), rheumatoid C1-2 instability (14 cases), os odontoideum (four cases), traumatic C1-2 ligamentous instability (three cases), or instability secondary to a C-2 tumor (one case). In each case, the atlantoaxial arthrodesis utilized sublaminar wire at C-1 and incorporated an iliac-crest strut-graft positioned between the posterior arches of C-1 and C-2, held in place by securing wire around the base of the spinous process of the axis. Follow-up examination was performed in all patients after a mean postoperative duration of 33.

Atlantoaxial stabilization in rheumatoid arthritis.

Atlantoaxial subluxation in patients with rheumatoid arthritis is common. Operative stabilization is clearly indicated when signs and symptoms of spinal cord compression occur. However, many recommend early operative fusion before evidence of appreciable neural compression occurs because 1) the myelopathy in these patients may be irreversible; 2) the overall prognosis is poor once symptoms of cord compression are present; and 3) the risk of sudden death associated with atlantoaxial subluxation is increased even in asymptomatic patients.

Cruciate paralysis: a clinical and radiographic analysis of injuries to the cervicomedullary junction.

Fourteen patients with superior cervical spinal cord injuries and the clinical signs and symptoms of cruciate paralysis are presented. This rare injury pattern is characterized by weakness of the upper extremities with little or no compromise of lower-extremity function following trauma to the superior spinal cord. Anatomically, cruciate paralysis is thought to represent selective injury to descending corticospinal tracts as they decussate at the cervicomedullary junction.

Management of spinal cord trauma.

Spinal cord injuries disproportionately affect young males in their peak wage-earning years, with catastrophic personal and economic consequences. New pharmacological and surgical interventions have evolved from extensive research on the pathophysiology and biomechanics of SCI. Management of SCI must be individualized and will depend on the level and severity of the injury and the patient's medical condition.

Surgical approaches to the thoracolumbar spine.

Pathology affecting the spinal cord structures and/or vertebral segments at the TLJ is not uncommon. Trauma is the most frequent cause of dysfunction-compression at these levels and may result in permanent neurological disability and vertebral column instability. Patients with TLJ pathology must be evaluated carefully and thoroughly with serial neurological examinations and diagnostic radiographic studies as outlined.

Synovial cysts of the lumbosacral spine: diagnosis by MR imaging.

Intraspinal synovial or ganglion cysts are uncommon lesions associated with degenerative lumbosacral spine disease. CT usually reveals cystic lesions adjacent to a facet joint, and they may show calcification. MR imaging of four surgically confirmed cases of intraspinal synovial cysts revealed subtle signal changes compared with CSF.

Acute axis fractures: a review of 229 cases.

Eighteen percent of acute cervical spine fractures involve the C-2 vertebra. The odontoid Type II fracture is the most common axis fracture and it is also the most difficult to treat. The degree of odontoid dislocation has been identified as the single most important fracture feature that helps separate those patients who have a high likelihood of healing with nonoperative therapy from those who are likely to fail nonoperative therapy and should be offered early surgical stabilization.

Synovial cysts of the lumbosacral spine: diagnosis by MR imaging.

Intraspinal synovial or ganglion cysts are uncommon lesions associated with degenerative lumbosacral spine disease. CT usually reveals cystic lesions adjacent to a facet joint, and they may show calcification. MR imaging of four surgically confirmed cases of intraspinal synovial cysts revealed subtle signal changes compared with CSF.

The transoral approach to the superior cervical spine. A review of 53 cases of extradural cervicomedullary compression.

The transoral-transclival surgical approach is the most direct operative approach to pathology ventral to the brain stem and superior spinal cord. In selected patients, this approach is efficacious in the treatment of extradural compressive lesions from the cervicomedullary junction to the C-4 vertebra. The authors have used the transoral surgical approach in treating 53 patients with lesions compressing the ventral extradural brain stem or the cervical cord.

Meningioangiomatosis: a case report.

A case of meningioangiomatosis without neurofibromatosis, a rare disorder, is described. These patients are usually young (mean age, 27 years) and frequently present with seizures that resolve following partial or total resection of the lesion. The lesions are firm and well demarcated grossly with areas of calcification.

The infant whiplash-shake injury syndrome: a clinical and pathological study.

The cases of 13 infants (median age, 3 months) who sustained nonaccidental trauma were reviewed. All presented with profound neurological impairment, seizures, retinal hemorrhages, and intracranial subarachnoid and/or subdural hemorrhages. Of 8 infants who died, autopsy was performed on 6.

Neurosurgical management of acute atlas-axis combination fractures. A review of 25 cases.

Combination atlas-axis fractures occur relatively frequently and have a higher incidence of neurological morbidity than isolated C-1 or isolated C-2 injuries. Patients with combination C1-2 fracture-subluxation injuries should be studied with thin-section computerized tomography. Appropriate treatment is determined by the type of axis fracture present and includes surgical and nonsurgical strategies.

Developmental accumulation and heterogeneity of myelin basic protein transcripts in the chick visual system.

By selective cloning of gene products newly expressed in the developing chick optic tectum, we have isolated cDNA clones encoding myelin basic protein (MBP). Three different transcripts of the corresponding single copy gene of 2.7 kb, 2.