Abstract. A series of 99 cases of acute central cervical spinal cord syndrome is reviewed.This represents 25 per cent of all acute cervical spinal cord injuries (excluding stabs and gunshots), admitted to the Spinal Cord Injury Centre, Conradie Hospital during an 8-year period (November 1963 to December 1971. Aetiology, age incidence and relationship to injury is discussed.
Abstract. The orthopaedic and neurological lesions of 2 1 cases of spinal cord injuries as a result of motorcycle accidents are reviewed. The thoracic spine and spinal cord were the site of injury in 76 per cent of cases. Eighty-one per cent of the thoracic injuries showed complete neurological lesions. A mechanism of injury is postulated.
Abstract. A retrospective study of 3 02 cases of cervical spine facet interlocking with neurological signs is presented. These are reviewed as regards aetiology and neurological recovery. There appears to be a neurological advantage in reduction of facet interlocking in this series.
In total, 33 stents were placed in 28 male patients. SCI was cervical in 23 patients and thoracic in 5. Average follow-up was 18 months (range 1-40 months, median 18 months). The most common indications were repeated catheter blockage in eight patients and urinary tract infection in six. The average time from SCI to stent insertion was 79 months (range 1-468 months, median 21 months). Severe autonomic dysreflexia was present in 17 cases before stent placement and in 7 after stents were placed (P=0.003). Stents failed in 15 patients (45%) and were removed. The most common reason for failure was stone formation. Comparing the group of patients with stents lasting >20 months (n=11) to the group with stent removal before 20 months (n=10), the mean time between SCI and stent placement was 31 vs 119 months (P=0.057). Medium term results (up to 27 months) were significantly influenced by earlier stent placement (P=0.0484). One major complication was stent migration that caused an urethrocutaneous fistula.
Post-traumatic syringomyelia is estimated to develop in more than 20% of individuals with traumatic spinal cord injury (SCI). The development can give rise to clinical symptoms 6 months to 26 years after the injury, and presentation 40 years post-injury has been seen by one of the authors. 1 ± 4 We present an unusual case for comments and discussion.Keywords: spinal cord injury; post-traumatic syringomyelia; tetraplegia; progressive symptoms Case storyA forty-year-old man was involved in an accident as a passenger in a rally car, which rolled over several times. He was found to have fractures of the right 2nd and 3rd ribs with bilateral lung contusion, a fracture of the right scapula and right 2nd metacarpal bone. He was initially described as having normal sensation and movement of the legs. He was ventilated and sedated for the ®rst 8 days. Due to urinary retention and generally decreased strength in the lower extremities additional investigations were carried out and a T3 ± 4 fracture dislocation was diagnosed, with half a vertebral body slip anteriorly and laterally of T3 on T4. Thirteen days post-injury he was transferred to a neurosurgical department, where it was decided to continue conservative treatment of the fracturedislocation. Sensation still was found to be normal, including in the sacral segments, there was normal voluntary anal contraction, but the muscle strength in the lower extremities was around 4, and co-ordination was impaired. A few days later the patient could empty the bladder normally. Five-and-a-half weeks postinjury he was admitted to the rehabilitation department, and discharged after a further 8 weeks of rehabilitation. At discharge he had normal voiding and defecation, and was walking nearly normally. He had some co-ordination problems and sensory disturbance of the left leg, and a 10 cm broad band with dysaesthesia on the left thorax. He was not followed up after discharge.Approximately 8 years later he noticed light sensory disturbances ®rst in the right and later the left C 8 segment. An MRI was performed repeatedly over the next 3 years and showed, apart from the known fracture, a lobulated syrinx from the level of the fracture to the upper border of C5. In addition the MRI showed a 3 cm long intramedullary cyst at the level of T5. Fourteen years post-injury his symptoms had progressed with disturbed sensibility in all ®ngers except the thumbs, increasing coordination problems in the right leg, and urinary retention necessitating intermittent catheterisation, together with loss of ejaculation, impaired erection, and increasing di culty in controlling defaecation. An MRI showed the syrinx had increased in size cranially, with only minimal medullary tissue remaining (Figure 1). Fifteen years post-injury he was transferred to our department and a syringoperitoneal shunt was performed. At the time of operation he was almost anaesthetic and analgesic below T 4 , but he could walk without aids. After the operation there was some regression of the sensory disturbances in the hands. T...
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