Objective To explore the factors to affect severity of hyperextension injury of the cervical spinal cord (HEICSC). Methods Forty-five patients with HEICSC, 35 males and 10 females, aged 27-67 years old (mean 48.2 years old), were retrospectively analyzed. The disease course was 30 minutes to 16 days. According to modified Frankel grading, there were 6 cases of grade A, 8 cases of grade B, 16 cases of grade C and 15 cases of grade D. Spinal cord injuries (SCI) segments were determined according to SCI plane and high signal change (HSC) in spinal cord on MR images. The whole or large part of HSC segments were supposed to be main injured spinal cord segments (MISCSs) and the staccato or patchy HSC ones were supposed to be common injured spinal cord segments (CISCSs). When the external force acting on head or face suffered was larger, the force produced during high-speed movement or forehead and/or face had severe contused and/or) lacerated wound, the force was defined severe traumatic strength, whereas the reverse was true for sl ight traumatic strength. According to signal magnitude of the cervical discs on T2-weighted MR images, degeneration of cervical discs and cervical vertebras were classified into 5 grades: grade 0-4. Cervical spinal stenosis were graded to 5 grades according to the width of anterior or posterior cerebrospinal fluid layer to spinal cord on T2-weighted MR images and compressed degree of spinal cord on T1-weighted MR images. The influence of traumatic strength, cervical spinal degeneration or cervical spinal stenosis on SCI were explored. Results Among the 45 cases, 12 cases were caused by sl ight traumatic strength, 33 cases were caused by severe one. The cervical spinal cord was injuried more sl ightly and the patients were older in the sl ight traumatic strength cases than in the severe ones (P lt; 0.05). The number of MISCSs were 45 in 40 cases and the 25 segments were located at C3, 4 level. The number of CISCSs were 39 in 21 cases. All the cervical vertebraes of the 45 patients had degenerated. The most were in grade 3 in 22 patients and the severest degenerative segments were mostly located in C5,6 discs in 35 ones. The number of the MISCSs in different degenerative grades of discs was 0 in grade 0, 9 in grade 1, 20 in grade 2, 14 in grade 3, and 2 in grade 4. The ratios of the segment number of injuried spinal cord to the segment number of spinal stenosis in every grade of stenosis were 1/62 in grade 0, 2/11 in grade 1, 27/52 in grade 2, 33/33 in grade 3, 21/22 in grade 4. Conclusion Three main factors including the magnitude of traumatic strength, the degree of instabil ity of cervical vertebrae and the degree of cervical stenosis contribute to development and progress of HEICSC.
In order to investigate the clinical significance of electron-neurogram for evaluating the degree and prognosis of acute traumatic cervical spinal cord injury without fracture or dislocation, electron-neurogram and sensory evoked potential (SEP) of the upper limbs in 4 such cases were recorded from the 3rd to 30th day after the injury. The results showed SEP and MEP could be obtained from every nerve in both upper limbs, and continous monitoring of SEP and MEP could provide valuable data to judge the degree and prognosis of the injury in spinal cord.
ObjectiveTo explore the practice of the evidence-based treatment strategy for cervical spinal cord injury. MethodsOne patient with cervical spinal cord injury was admitted to our hospital on January 3, 2013. We obtained medical evidences by searching databases and regulated the best treatment after evaluating the patient's comprehensive conditions. And then, the whole treatment strategy was fully implemented. Finally, the consequent results were evaluated. ResultsThe evidence-based medicine showed that the therapeutic targets were to save the residual function, prevent complications, and promote the recovery of neural function. Based on the real-time conditions of patient, we developed and practiced the evidence-based comprehensive rehabilitation programs, including absolute rest in bed, high-dose steroids, neurotrophic drugs, Chinese medicine rehabilitation and prevention of complications. After a follow-up of half a year, the patient obtained a good curative effect. The patient was saved from paralyzing. Moreover, the patient restored the capacity of standing, walking and a certain level of self-care ability. ConclusionFor the cervical spinal cord injury, treatment decision based on evidence-based medicine is more scientific, and it can ensure maximum benefit for the patients. Therefore, it is worthy of popularizing.
ObjectiveTo observe the effect of Mongolian medicine fumigation combined with sciatic nerve and rectal probe electrical stimulation on muscle spasticity of spinal cord injury.MethodsBetween January 2012 and January 2018, a total of 65 patients with muscle spasticity after spinal cord injury were randomly divided into two group: the observation group (32 cases) and the control group (33 cases). The patients in the observation group were treated with Mongolian medicine (Wu Wei Gan Lu-Decoction) fumigation combined with sciatic nerve and rectal probe electrical stimulation, while the patients in the control group were treated with medicine, physical therapy, and exercise therapy. Both two groups were treated for 8 weeks. The patients were scored with Ashworth Score, American Spinal Injury Association (ASIA) score, and Barthel Index before and after treatment.ResultsThe pre-treatment ASIA scores (light touch sensation, pain sensation, and muscle strength) and Barthel Index of the two groups were not statistically significant (P>0.05). The post-treatment ASIA scores and Barthel Index of both groups performed significantly better than the pre-treatment levels (P<0.05). The post-treatment ASIA muscle strength item was 58.55±10.83 in the observation group and 50.69±11.32 in the control group (P<0.05). The post-treatment Barthel Index was 74.22±11.53 in the observation group and 68.46±9.92 in the control group (P<0.05). The effective rate in the observation group was significantly better than that in the control group (84.4% vs. 60.6%, P<0.05). Conclusion Mongolian medicine fumigation combined with sciatic nerve and rectal probe electric stimulation could improve the muscle spasticity of spinal cord injury and patients’ ability of daily life effectively.