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L1 Burst Fracture with Kyphosis
Published in Kelechi Eseonu, Nicolas Beresford-Cleary, Spine Surgery Vivas for the FRCS (Tr & Orth), 2022
Kelechi Eseonu, Nicolas Beresford-Cleary
If review of the CT revealed no further concern for posterior column injury, given that the patient is neurologically intact, the injury is stable and there is no indication for an MRI. There is no high-quality evidence demonstrating the superiority of operative versus non-operative management of these injuries, and I would therefore elect to manage this non-operatively. Following administration of appropriate analgesia, I would obtain upright X-rays to ensure that the alignment and kyphosis are still within acceptable limits when loadbearing.
Spinal Injuries
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
The combination of hyperflexion with rotation is much more likely to produce significant injury to the cervical and thoracic spine than other mechanisms. Between 50% and 80% of all cervical spine injuries and most thoracolumbar injuries are caused by this mechanism. Such injuries often follow RTCs or direct trauma. There is significant disruption of the posterior ligamentous complex and the posterior column of the spine. The facet joints, lamina, transverse processes and vertebral bodies may fracture. In the cervical region the relatively flat facet joints may dislocate, without causing a fracture. The spinous processes of C6/7 can also be avulsed by the interspinous ligaments (the ‘Clay-shoveller’s fracture’). With greater shearing forces, all the intervertebral ligaments may tear and the upper vertebral body can be displaced relative to the one below.
Cervical spine injury
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
The classic assessment of instability of an acute traumatic spine injury is based on the three-column spine concept, which was first described in 1984 by Denis.16 This model divides the spine into three columns in the sagittal plane. The anterior column is formed by the anterior longitudinal ligament, the anterior half of the vertebral bodies, and discs. The middle column is formed by the posterior vertebral bodies and discs, the posterior longitudinal ligament, and synovial joints. The posterior column is formed by the laminae, spinous processes, and posterior ligaments of the spine. An injury that disrupts any two or more of these conceptual columns makes the spine unstable.
Posterior cord syndrome associated with postoperative seroma: The case to perform a complete neurologic exam
Published in The Journal of Spinal Cord Medicine, 2020
Meghan Cochrane, Marika Hess, Natalie Sajkowicz
The posterior column transmits the sensations of vibration, position sense, deep pressure and two-point discrimination. Loss of vibration and proprioception below the level of the lesion are hallmarks of posterior cord syndrome which are not routinely tested during the standard ISNCSCI examination.4 Therefore disorders that are limited to the posterior column can easily be missed or overlooked when performing the standard ISNCSCI examination. Dorsal column pathology resulting in posterior cord syndrome causes sensory ataxia and unstable gait, which can have a huge impact on function. Though this patient’s motor examination remained stable, his functional impairments changed significantly from his preoperative baseline. His balance deficits resulted in an inability to stand and remain in his home. With rehabilitation, he was able to return to baseline function and return home.
Thoracic spine ossified ligamentum flavum: single-surgeon experience of fifteen cases and a new MRI finding for preoperative diagnosis of dural ossification
Published in British Journal of Neurosurgery, 2020
Spasticity and gait ataxia were the first and the most consistent symptoms to improve in all patients. There was also improvement in bladder symptoms. Numbness improved only to a modest degree but was not deemed disabling by any of the subjects. One patient had persistent lower limb mild posterior column dysfunction. At the last FU visit, 13 patients could walk independently while two required external support for ambulation (one requiring minimal support) and the recovery rate was similar between the two groups. Furthermore, the proportion of patients attaining independent mobility was also similar between the two groups. A higher preoperative Nurick grade was associated with better clinical improvement after surgery. Grade V had poorer recovery than other grades (two out of five Nurick grade V cases had a poor recovery).
Posterior column ataxia with retinitis pigmentosa (PCARP) in an Iranian patient associated with the FLVCR1 gene
Published in Ophthalmic Genetics, 2020
Fahimeh Beigi, Marta Del Pozo-Valero, Inmaculada Martin-Merida, Mohammad Yahya Vahidi Mehrjardi, Masoud Reza Manaviat, Amir Sherafat, Carmen Ayuso, Nasrin Ghasemi
The differential diagnosis for RP and neurologic degeneration includes Refsum disease, other peroxisomal disorders, beta-lipoproteinemia, neuropathy, ataxia and RP (NARP), rare forms of Charcot–Marie–Tooth, PNPLA6-related disorders, and disorders of copper metabolism. Plasmatic phytanic acid level, vitamin E levels, B12 levels, ceruloplasmin level, cholesterol levels, and plasma lactate levels were all normal. There was no evidence of demyelination, and audiometry was within normal limits distinguishing from Refsum disease or other Zellweger spectrum disorders. Interestingly, despite posterior column neurologic findings on examination (areflexia and reduced proprioception), spinal MRI was within normal limits and no posterior column hyperintensity was observed, as it was previously reported by Puffenberger et al. (7).