RESUMO
Background Traumatic spinal cord injury (TSCI) is extremely costly to the global health system. Due to the significant frequency rate of traumatic cervical spinal cord injuries (TCSCI), the possible association between imaging findings and clinical outcome is not yet clear. In this study, we quantified maximum spinal cord compression and maximum cord swelling following TCSCI and determined the relevance of imaging findings to clinical outcome in patients. Materials and Methods This retrospective cohort comprises 20 patients with TCSCIs (C3-C7), classified as complete, incomplete, and no SCI, who were treated at the Poursina Hospital, Iran, from 2018 to 2020, and underwent spinal surgery. Patients with penetrating injuries and multiple trauma were excluded. Imaging findings revealing spinal cord compression, swelling, and canal stenosis, based on the American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades of patients from hospital admission (up to 48 hours after injury) and improvement of postoperative neurological symptoms (612 months) were evaluated. Results Cord compression (p » 0.05) and cord swelling (p » 0.02) were significantly related to predictive neurological outcomes in all cases. Evaluation with AIS at hospital admission and at 6 to 12 months postoperatively showed significant correlation with fracture type (p » 0.05) and the longitudinal length of the intramedullary lesion (IML); p » 0.01, respectively. Conclusion According to the results obtained in this study, it may be concluded that there is a significant association between cervical spinal cord compression and swelling, and clinical outcomes in patients with complete, incomplete, and no SCI.
Introdução A lesão traumática da medula espinal (LTME) é extremamente onerosa para o sistema de saúde global. Devido à significativa taxa de frequência de lesões traumáticas da medula espinal cervical (TCSCI), a possível associação entre achados de imagem e evolução clínica ainda não está clara. Neste estudo, quantificamos a compressão medular máxima e o edema medular máximo após TCSCI e determinamos a relevância dos achados de imagem para o resultado clínico dos pacientes. Materiais e métodos Esta coorte retrospectiva compreende 20 pacientes com TCSCIs (C3-C7), classificados como completos, incompletos e sem LME, que foram tratados no Hospital Poursina, Irã, de 2018 a 2020, e submetidos a cirurgia da coluna vertebral. Pacientes com lesões penetrantes e politraumatismos foram excluídos. Achados de imagem revelando compressão da medula espinhal, edema e estenose do canal, com base nos graus da American Spinal Injury Association (ASIA) Impairment Scale (AIS) de pacientes desde a admissão hospitalar (até 48 horas após a lesão) e melhora dos sintomas neurológicos pós-operatórios (6-12 meses) foram avaliados. Resultados A compressão do cordão (p = 0,05) e o edema do cordão (p = 0,02) foram significativamente relacionados aos desfechos neurológicos preditivos em todos os casos. A avaliação com AIS na admissão hospitalar com 6 a 12 meses de pós-operatório mostrou correlação significativa com o tipo de fratura (p = 0,05) e o comprimento longitudinal da lesão intramedular (IML); p = 0,01, respectivamente. Conclusão De acordo com os resultados obtidos neste estudo, pode-se concluir que existe uma associação significativa entre compressão e edema da medula espinal cervical e desfechos clínicos em pacientes com lesão medular completa, incompleta e sem lesão medular.
RESUMO
Introducción: La gravedad, las implicancias neurológicas y el alto costo del tratamiento de la fractura cervical, hacen de esta lesión un tema de suma importancia. Esta injuria provoca graves limitaciones e invalidez a los afectados, en su mayoría en plena actividad laboral, impactando en lo médico, social y económico. Objetivos: Describir los pacientes tratados quirúrgicamente de fractura cervical traumática en el Hospital Regional Rancagua, por el equipo de Neurocirugía dentro de un periodo de 4 años. Materiales y Métodos: Se evaluó - 24 pacientes con antecedente de fractura cervical el mecanismo del trauma, el tiempo transcurrido desde el ingreso hospitalario hasta la cirugía, nivel y compromiso de la lesión medular, tipo de abordaje quirúrgico, complicaciones médicas, quirúrgicas y seguimiento post-operatorio, entre otros. Resultados: 5 mujeres y 19 hombres, edad promedio 39 años (rango de edad 14 a 75 años), principales mecanismos de trauma fueron los accidentes automovilísticos-atropello (58 por ciento). El nivel medular más frecuentemente lesionado fue C4-C5 (25 por ciento). En el 50 por ciento de los pacientes se clasificó de entrada como Frankel A, por lo que un 50 por ciento de todos los pacientes ingresaron tetrapléjicos, y de estos, un 33 por ciento egresó tetraparéticos. Del ingreso a cirugía hubo un tiempo de espera promedio 5 días. Dentro de las complicaciones médicas la causa respiratoria (46 por ciento) fue la más frecuente, necesitando 64 por ciento de estos pacientes ventilación mecánica. Se registró 1 infección de herida operatoria donde el abordaje fue posterior. El Índice de Barthel promedio de 14 pacientes fue de 49 puntos. De 6 pacientes con puntaje Cero, 85 por ciento de estos ingresaron como Frankel A y 50 por ciento egresaron tetrapléjicos. Los pacientes se rehabilitaron en promedio de 2.5 meses. Discusión: Logramos objetivar nuestra realidad. La técnica quirúrgica fue prácticamente uniforme entre los pacientes, sin complicaciones...
Introduction: Gravity, neurological implications and high costs of treating cervical fracture, makes of this injury an issue of most importance. This injury causes severe limitations and disability to those affected, mostly in full working activity, impacting on the medical, social and economic. Objectives: To describe patients surgically treated for traumatic cervical fracture at the Rancagua Regional Hospital, by the team of Neurosurgery Department, within a period of 4 years. Materials and Methods: We evaluated 24 patients with an history of cervical fracture mechanism of trauma, the time from hospital admission to surgery, and commitment level of spinal cord injury, type of surgery, medical and surgical complications and follow-up post -operation, among others. Results: 5 women and 19 men, average age 39 years (ranging age from 14 to 75 years), major trauma mechanisms were motor vehicle accidents (58 percent). The most frequently injured spinal level was C4-C5 (25 percent). 50 percent of patients were classified as Frankel A at the admission, so that 50 percent of all patients admitted were quadriplegics, and of these, 33 percent were discharged as tetraparétic. Admission to the surgery were an average of 5 days. Within cause respiratory medical complications (46 percent) was the most frequent, requiring 64 percent of these patients mechanical ventilation. There was only 1 wound infection where the approach was posterior. The average Barthel Index of 14 patients was 49 points. In 6 patients with zero score, 85 percent were admitted as Frankel A and 50 percent egressed as tetraplejic. Patients were rehabilitated an average of 2.5 months. Conclusions: We were able to objectify our reality. The surgical technique was nearly uniform among patients without severe postoperative surgical complications...