In this prospective observational study, we investigated the
time-dependent changes and correlations of upper arm performance
tests (ten-second test and Simple Test for Evaluating Hand Function
(STEF), the Japanese Orthopaedic Association (JOA) score, and the
JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) in 31
patients with cervical myelopathy who had undergone surgery. We hypothesised that all the indices correlate with each other,
but show slightly different recovery patterns, and that the newly
described JOACMEQ is a sensitive outcome measure.Aims
Patients and Methods
C5 nerve root palsy is a rare and potentially
debilitating complication of cervical spine surgery. Currently,
however, there are no guidelines to help surgeons to prevent or
treat this complication. We carried out a systematic review of the literature to identify
the causes of this complication and options for its prevention and
treatment. Searches of PubMed, Embase and Medline yielded 60 articles
for inclusion, most of which addressed C5 palsy as a complication
of surgery. Although many possible causes were given, most authors supported
posterior migration of the spinal cord with tethering of the nerve
root as being the most likely. Early detection and prevention of a C5 nerve root palsy using
neurophysiological monitoring and variations in surgical technique
show promise by allowing surgeons to minimise or prevent the incidence
of C5 palsy. Conservative treatment is the current treatment of
choice; most patients make a full recovery within two years. Cite this article:
The most common injury in rugby resulting in
spinal cord injury (SCI) is cervical facet dislocation. We report
on the outcome of a series of 57 patients with acute SCI and facet
dislocation sustained when playing rugby and treated by reduction
between 1988 and 2000 in Conradie Hospital, Cape Town. A total of
32 patients were completely paralysed at the time of reduction.
Of these 32, eight were reduced within four hours of injury and
five of them made a full recovery. Of the remaining 24 who were
reduced after four hours of injury, none made a full recovery and only
one made a partial recovery that was useful. Our results suggest
that low-velocity trauma causing SCI, such as might occur in a rugby
accident, presents an opportunity for secondary prevention of permanent
SCI. In these cases the permanent damage appears to result from
secondary injury, rather than primary mechanical spinal cord damage.
In common with other central nervous system injuries where ischaemia
determines the outcome, the time from injury to reduction, and hence
reperfusion, is probably important. In order to prevent permanent neurological damage after rugby
injuries, cervical facet dislocations should probably be reduced
within four hours of injury.
Forty patients with a whiplash injury who had been reviewed previously 2 and 10 years after injury were assessed again after a mean of 15.5 years by physical examination, pain and psychometric testing. Twenty-eight (70%) continued to complain of symptoms referable to the original accident. Neck pain was the commonest, but low-back pain was present in half. Women and older patients had a worse outcome. Radiating pain was more common in those with severe symptoms. Evidence of psychological disturbance was seen in 52% of patients with symptoms. Between 10 and 15 years after the accident 18% of the patients had improved whereas 28% had deteriorated.
Twenty-two cases of paraplegia complicating injury of the cervical column have been reviewed. The vertebral injury may be due to flexion or hyperextension violence.
Spondylolisthesis of the fourth cervical vertebra is reported in a thirty-four-year-old woman. Only one other case at this level has been found in the literature, but others have been recorded of the sixth cervical vertebra.
1. In thirty-six out of seventy-two cases of cervical vertebral interlocking, luxation was still present after two weeks ("old luxation"). The principal reasons for overlooking the diagnosis are lack of familiarity with the radiographic appearances and incomplete or inadequate radiographic examination. 2. Failure to identify luxation probably hardly influences the prognosis of the immediate cord lesion; but recovery from the radicular lesion is unfavourably affected, and a progressive cord lesion may occur later when none previously existed. 3. Reduction is advisable if the luxation is not more than six weeks old. Operative reduction is preferred; manual reduction under anaesthesia and caliper traction with heavy weights are less satisfactory alternatives. Reduction is contra-indicated if the luxation is more than six weeks old. 4. Indications for fixation and the choice between internal and external (plaster jacket) fixation are discussed, and also the treatment of stable lesions which have not been reduced.
1. Evidence is presented that certain types of cervical spine injury are due mainly to lateral flexion forces. 2. These injuries are often complicated by a brachial plexus lesion as well as a lesion of the spinal cord. 3. It is not always easy to detect the brachial plexus injury when the patient is first seen. 4. In the cases reviewed there has been little or no recovery of cord function, and the existence of a brachial plexus injury has, of course, made rehabilitation much more difficult. 5. The practical importance of recognising the mechanism of this type of injury is that treatment which will cause further separation of the vertebrae is inadvisable.
We describe five patients with cervical spondylosis and large anterior osteophytes causing pharyngeal compression. All had dysphagia, two had obstructive sleep apnoea and another two had dyspnoea and stridor on inspiration. One, with perforation of the pharynx, required emergency tracheostomy. Only three had pain in the neck or arm. Compression of the retroglottic space was confirmed in all patients by pharyngoscopy and in all the symptoms were relieved by excision of the osteophytes. Three also underwent intervertebral fusion. One had some persistent sleep apnoea.
