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Thread: Stretch Injury Question

  1. #1

    Stretch Injury Question

    1. What damages do the spinal cord sustain when you have neither fractured nor dislocated vertebrae?

    2. What is a cystic lesion?


  2. #2
    What was the mechanism of injury? Spinal cord injury can occur due to both traumatic and non-traumatic causes. The cord can be bruised, cut, torn, crushed, or overstretched. Its circulation can be cut off by the injury itself or by lesions inside the cord such as AVMs or by a spinal cord "stroke". Surgery on the aorta can also cause spinal cord stroke. Infections and tumors can also occur in the cord or in the bone of the spine, causing a pathologic fracture that damages the cord. Disks can rupture, or spinal stenosis can pinch the cord.

    There can be damage to the circulation of the cord from both traumatic and non-traumatic causes as well. Gun shot wounds can cause damage to the cord from both heat and shock-wave even if the bullet does not pass directly through the cord. At the instant of injury, dislocation can occur which may not be detected later if there are no fractures, tears of ligiments or locking of the bones.

    A cystic lesion means some type of cyst, which is a cavity filled with fluid. In the cord it is usually a syrinx. In other areas it can be an abscess or part of a tumor. Primary syringomyelia (a syrinx) can occur in a person without a pre-existing spinal cord injury, an often does not show symptoms until the 20s or later. Following spinal cord injury, a cyst or syrinx (post-traumatic or secondary syringomyelia) can occur and make the spinal cord injury worse.

    (KLD)

  3. #3
    The injury was caused by an automobile accident. I was first told it was a stroke, next I was told it was stretching of my neck, and then another doctor told me it was subarachnoid hemorrhaging. One doctor said it was the strangest case he had ever seen. I'm just trying to figure out what was the cause of the lesion so I can know what my therapy options are.

    Thank You

  4. #4
    After the immediate acute period, the actual mechanism does not make a lot of difference in outcome or treatment. What options are you looking at?

    (KLD)

  5. #5
    I only did 3 weeks of rehab, so I was thinking of asking my doctor if I could possibly do more. I've gotten return of some movent over time, initially I wasnt able to shrug my shoulders, now I can move both arms and my middle finger on both hands. Though my right arm is not functional. What type of therapy or trials do you think would be best?

  6. #6
    Quote Originally Posted by krisb601
    I only did 3 weeks of rehab, so I was thinking of asking my doctor if I could possibly do more. I've gotten return of some movent over time, initially I wasnt able to shrug my shoulders, now I can move both arms and my middle finger on both hands. Though my right arm is not functional. What type of therapy or trials do you think would be best?
    Krisb601,

    The name of your condition is Spinal Cord Injury Without Radiological Abnormality or SCIWORA. Although more common in children, it can happen in adults. The treatment for this should not be any different from spinal cord injury with fractures. Do you have movement in your legs? If so, you have what would be called a central cord syndrome where the arms are more affected than the legs.

    Here are some recent abstracts of studies on the subject.

    Wise.

    References
    1. Tewari MK, Gifti DS, Singh P, Khosla VK, Mathuriya SN, Gupta SK and Pathak A (2005). Diagnosis and prognostication of adult spinal cord injury without radiographic abnormality using magnetic resonance imaging: analysis of 40 patients. Surg Neurol 63: 204-9; discussion 209. BACKGROUND: Spinal cord injury without radiographic abnormality (SCIWORA) is not uncommon among middle-aged and elderly people. It is less reported in adults as compared with children. This study was undertaken to find the incidence, magnetic resonance imaging (MRI) changes, and outcome of SCIWORA in adults and to demonstrate the prognostic value of MRI in SCIWORA. MATERIALS AND METHODS: Forty adult patients who sustained SCIWORA for a period of 2 years (January 1999 to December 2000) were admitted to our hospital. Methylprednisolone was given in therapeutic doses, for a period of 24 hours, to those arriving within 6 hours of injury. Magnetic resonance imaging was performed within 72 hours of admission to the hospital. In all patients, sagittal, axial, and coronal T1, spin, and T2 images of MRI were obtained. Clinical status of the patient at the time of admission and discharge was correlated with MRI. RESULTS: Four patients (10%), who were in Frankel grade D, with no demonstrable injury on MRI, improved to Frankel grade E at the time of discharge. Two patients (5%) with cord edema and extraneural injury improved to a useful neurological grade (Frankel grades D or E), whereas 13 patients (32.5%) with MRI features of cord contusion and hemorrhage did not achieve useful neurological function. CONCLUSION: Spinal cord injury without radiographic abnormality contributes 12% of cases of spinal cord injury. Magnetic resonance imaging is the investigation of choice, having diagnostic and prognostic value because it demonstrates neural and extraneural injuries and helps to pick up surgically correctable abnormality. Patients with minimal cord changes on MRI have the best outcome followed by those with cord edema. Patients with parenchymatous hemorrhage and contusion on MRI fare badly. Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15734500
    2. Wenger M, Adam PJ, Alarcon F and Markwalder TM (2003). Traumatic cervical instability associated with cord oedema and temporary quadriparesis. Spinal Cord 41: 521-6. STUDY DESIGN: A case report of blunt cervical spine trauma associated with cord oedema at the C3/C4 level with temporary Frankel/American Spinal Injury Association Grade A quadriparesis and motion segment instability without evidence of associated bony lesions (spinal cord injury without radiological abnormality, SCIWORA lesion). OBJECTIVES: By means of a rare and illustrative case, the reader's attention is focused on eventual marked cervical motion segment instability in SCIWORA patients. SETTING: A department of Neurology in Quito, Ecuador and a department of Neurosurgery in Bern, Switzerland. METHOD: A 73-year-old man sustained blunt cervical spine trauma. After resolution of paraparesis, dynamic studies of the cervical spine revealed translational instability of C3 over C4. The patient underwent segment fusion by intervertebral cage insertion and plate fixation. RESULTS: The patient had recovered almost completely from tetraparesis under conservative treatment. The postoperative course was uneventful. Solid bony fusion of the C3/C4 motion segment was obtained. CONCLUSION: Despite normal cervical alignment, the lack of bony lesions and neurological recovery, magnetic resonance imaging and dynamic studies may reveal marked translational cervical motion segment instability requiring segment fusion in order to prevent ongoing damage of the spinal cord. Neurosurgery, The Hirslanden Group, Klinik Beau-Site Bern, Switzerland. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=12934094
    3. Hendey GW, Wolfson AB, Mower WR and Hoffman JR (2002). Spinal cord injury without radiographic abnormality: results of the National Emergency X-Radiography Utilization Study in blunt cervical trauma. J Trauma 53: 1-4. BACKGROUND: The purpose of this study was to better define the incidence and characteristics of patients with spinal cord injury without radiographic abnormality (SCIWORA), using the database of the National Emergency X-Radiography Utilization Study (NEXUS). METHODS: This was a prospective, observational study of blunt trauma patients in 21 U.S. medical centers undergoing plain cervical radiography. SCIWORA was defined as spinal cord injury demonstrated by magnetic resonance imaging, when a complete, technically adequate plain radiographic series revealed no injury. RESULTS: Of the 34,069 patients entered, there were 818 (2.4%) with cervical spine injury, including 27 (0.08%) patients with SCIWORA. Over 3,000 children were enrolled, including 30 with cervical spine injury, but none had SCIWORA. The most common magnetic resonance imaging findings among SCIWORA patients were central disc herniation, spinal stenosis, and cord edema or contusion. Central cord syndrome was described in 10 cases. CONCLUSION: In the large NEXUS cohort, SCIWORA was an uncommon disorder, and occurred only in adults. University of California San Francisco-Fresno, CA 93702, USA. hendey@ucsfresno.edu http://www.ncbi.nlm.nih.gov/entrez/q..._uids=12131380
    4. Kothari P, Freeman B, Grevitt M and Kerslake R (2000). Injury to the spinal cord without radiological abnormality (SCIWORA) in adults. J Bone Joint Surg Br 82: 1034-7. Injury to the spinal cord without radiological abnormality often occurs in the skeletally immature cervical and thoracic spine. We describe four adult patients with this diagnosis involving the cervical spine with resultant quadriparesis. The relevant literature is reviewed. The implications for initial management of the injury, the role of MRI and the need for a high index of suspicion are highlighted. Department of Diagnostic Radiology, University Hospital, Queen's Medical Centre, Nottingham, England, UK. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=11041597
    5. Gupta SK, Rajeev K, Khosla VK, Sharma BS, Paramjit, Mathuriya SN, Pathak A, Tewari MK and Kumar A (1999). Spinal cord injury without radiographic abnormality in adults. Spinal Cord 37: 726-9. Spinal cord injury without fractures or bony malalignment on either plain radiographs or computed tomography (SCIWORA) is most commonly found in the paediatric age group. In recent years, magnetic resonance imaging (MRI) has been used to evaluate these patients. The present communication describes SCIWORA in 15 adult patients investigated by MRI. Of the 151 patients with spinal cord injury in 1 year, 15 adult patients had cervical SCIWORA. All patients were evaluated by MRI. The age ranged from 20 - 60 years. Eleven patients had partial cord injury, two had a complete cord syndrome while two had a central cord syndrome. MRI demonstrated an intervertebral disc prolapse in six patients, intramedullary haematoma/contusion in four and cord oedema in four patients. One patient had multiple disc prolapses and associated intramedullary haematoma. Patients with disc prolapse were operated upon and all showed neurological improvement. The rest of the patients were managed conservatively. There was mild improvement in patients with intramedullary haematomas while those with cord oedema alone showed moderate recovery. The pathogenesis of adult SCIWORA is possibly different from that in paediatric age group. Most of the patients with SCIWORA show some abnormality on MR imaging. MRI should therefore be done in all patients with spinal cord injury for diagnostic and prognostic purposes. Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=10557129

  7. #7
    Thank you, no I have no movement in my legs. The only treatment I received was steroids. Would a decompression surgery help at this point in the injury?

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