Spine fracture in patient with ankylosing spondylitis: A case report

Spinal fractures in patients with ankylosing spondylitis may be the result of minor trauma. These fractures may lead to severe neurological deficits, and they are difficult to detect using standard radiography. Often, CT-scans and MRI are required for diagnosis.     

强直性脊柱炎并发脊柱脊髓损伤的治疗

目的 探讨强直性脊柱炎并发脊柱脊髓损伤的治疗方法。方法 回顾12例强直性脊柱炎并发脊柱脊髓损伤患者的临床治疗过程与结果,比较不同的治疗方案。结果与结论 积极防治并发症尤其是肺部感染是治疗的首要任务,应先进行保守治疗,有手术指征者尽早接受手术治疗。     

Multi-stage management of multiple severe decubitus ulcers in a patient with spinal cord injury: A case report

The article presents the multi-stage treatment of severe decubitus ulcers in a male patient, 26 years of age, with posttraumatic tetraplegia resulting from a cervical spinal cord injury that had occurred 8 years prior to admission. The patient presented with extensive and deep ulcerations in the sacral region and both trochanteric regions. Due to the destruction of the joint bilateral hip resection was also necessary. The entire hospital stay lasted 7 months and resulted in complete healing of all three decubitus lesions. There was no recurrence of pressure ulcers during the 2-year observation period.     

Increased spasticity in a chronic spinal cord injury patient after scabies infestation: A case report

Spasticity is a common feature of spinal cord injury (SCI). Spasticity exacerbation is commonly encountered with nociceptive and exteroceptive stimuli including bladder and bowel dysfunction, pressure sores, contracture, tight-fitting leg bags and clothing, and ingrown toenail. This report describes a patient with chronic SCI (T4 level) who complained of increasing spasticity of bilateral lower extremities for 5 weeks. He also had skin lesions on different parts of his body, accompanied by itching above the spinal cord lesion level. A clinical diagnosis of scabies was made and pharmacologic treatment was initiated. Following treatment, spasticity was significantly reduced and the skin rash with itching faded out. This report is the first of scabies skin infestation lesions triggering exacerbation of spasticity in an SCI patient.     

Twenty-seven years of complication-free life with clean intermittent self-catheterization in a patient with spinal cord injury: A case report

Currently, clean intermittent self-catheterization (CISC) is the most prevalent method of bladder management in patients with spinal cord injury (SCI) at discharge from rehabilitation centers. However, half of the patients discontinue using CISC and change to other methods of bladder management several months postdischarge despite the fact that it the best way to prevent urinary tract complications. Few studies, however, report the long-term consequences of CISC. In this case, we present a woman in her early fifties who had sustained thoracic SCI and had continued using CISC for 27 years without developing any complications. The possible reasons for her success were absence of incontinence because of underactive and normal capacity bladder; normal upper-extremity functions and absence of marked spasticity of lower extremities that facilitated CISC technique; and absence of sociovocational problems, enabling her to keep proper intervals between catheterizations each day. This case indicates that CISC is useful for long-term bladder management in patients with SCI, even for 25 years or more. Long-term outcomes of CISC and factors leading to success need to be delineated in future studies with larger samples.     

Acute myocardial infarction in a young man with ankylosing spondylitis: A case report

BACKGROUNDAnkylosing spondylitis (AS) is a chronic progressive inflammatory disease that mainly affects the spine and sacroiliac joints. To the best of our knowledge, AS with acute myocardial infarction (AMI) has rarely been reported. Here, we report an unusual case of AS with AMI in a young patient.CASE SUMMARYA 37-year-old man was admitted to the Department of Rheumatology and Immunology of our hospital on March 14, 2020, for low back pain. Further evaluation with clinical examinations, laboratory tests, and imaging resulted in a diagnosis of AS. Treatment with a non-steroidal anti-inflammatory drug and a tumor necrosis factor inhibitor partially improved his symptoms. However, his back pain persisted. After 6 wk of treatment, he was admitted to the emergency room of another hospital in this city for sudden-onset severe chest pain consistent with a diagnosis of AMI. Angiography revealed severe narrowing of the coronary arteries. Surgical placement of two coronary stents completely relieved his back pain.CONCLUSIONAS can cause cardiovascular diseases, including AMI. It is important to consider the cardiovascular risks in the management of AS.     

无骨折脱位型颈脊髓损伤临床研究进展

无骨折脱位型颈脊髓损伤迄今为止病因仍不清楚。大多认为与患者年龄、脊柱损伤类型及外伤力密切相关。其损伤机制多见于儿童和50岁以上患者,前者由于脊柱椎体关节面发育不全,颈椎存在不稳状态。后者常合并颈椎病,颈椎间盘退行性变,后纵韧带钙化,颈椎椎管狭窄及椎体不稳定等原始疾病。临床上主要表现为上肢运动功能受累明显而下肢受累程度较轻,直肠膀胱功能障碍及损伤平面以下感觉不同程度损害。对于无骨折脱位颈脊髓损伤的中老年患者主张手术治疗,认为虽然原有颈椎疾病的存在使颈椎结构装置失稳,但由于各种机制代偿使颈脊髓在此节段椎管内的顺应性增强,在椎管内相容性较好,故脊髓神经损伤不明显或较轻,然一旦突如其发瞬间外力形成,加之原有疾病启动,颈脊髓受到点状应力的冲击,失代偿状态,出现充血、出血、水肿等病理改变。椎管容纳有限,颈脊髓处于窘迫。因此,迅速减压手术可望拯救濒临缺血坏死脊髓神经组织、最大限度恢复神经功能。     

无骨折脱位型颈髓损伤的治疗

目的:探讨无骨折脱位型颈髓损伤(CSCIWFD)的治疗策略及临床疗效。方法:回顾性分析我科自2005年8月-2010年12月收治的51例CSCIWFD患者,根据日本骨科学会评分系统(JOA评分)分析CSCIW-FD患者治疗的短中期疗效。结果:全部患者随访6～60个月,平均24个月。43例患者采取手术治疗,JOA评分的平均改善率和优良率分别为(46.5±5.8)%和48.8%,均显著高于8例采取保守治疗患者JOA评分的平均改善率(25.6±3.1)%和优良率25.0%(P<0.01)。7d内手术的35例患者JOA评分的平均改善率和优良率分别为(50.6±3.6)%和54.3%,均明显高于7d后手术的8例患者JOA评分的平均改善率(37.5±2.9)%和优良率25.0%(P<0.01)。采用前路或后路手术的JOA评分平均改善率和优良率差异无统计学意义(P>0.05)。结论:根据CSCIWFD患者的影像学结果,选择合适的术式,尽早手术,可较好地改善颈脊髓功能,获得较满意的临床疗效。     

重度强直性脊柱炎患者纤支镜引导下清醒气管插管一例

强直性脊柱炎（AS）是一种以中轴关节受累为主的慢性炎症性疾病,严重者发生脊柱强直和畸形,属于困难气道的高危情况。该类患者术前应充分评估和准备,选择最佳麻醉方案,减少并发症发生。该文报道1例47岁男性腰椎、胸椎、颈椎强直,双髋关节、双膝关节强直呈“S”型固定体位的重度AS患者,因椎管内肿物拟于全身麻醉下接受手术治疗,使用右美托咪定清醒镇静在纤维支气管镜引导下气管插管的成功案例。该例提示右美托咪定清醒镇静不仅对呼吸功能影响轻微,而且能够提高患者接受操作期间的舒适度和配合度,为纤维支气管镜引导下气管插管提供满意的条件。     

Crohn's disease in a patient with acute spinal cord injury: a case report of diagnostic challenges in the rehabilitation setting

Diagnosis of the abdominal emergency in tetraplegic and high paraplegic patients remains challenging. Classic peritoneal signs, such as a rigid abdomen, rebounding, guarding, and Murphy's sign may be absent, whereas subtle physical, laboratory, or radiologic abnormalities may be the only evidence for an acute abdomen. Our report describes the course of a 70-year-old man with C5 American Spinal Injury Association class A tetraplegia who developed a perforated cecum secondary to Crohn's disease. We review the visceral and somatic sensory pathways for abdominal pain with emphasis on the challenges in assessing the acute abdomen in a patient with spinal cord injury (SCI). Recommendations for the assessment of the acute abdomen in an individual with SCI will be provided. This is the first reported case of Crohn's disease in an individual with an acute SCI. It shows the importance of maintaining high clinical suspicion for unexpected intraabdominal processes that may lead to significant morbidity and mortality if left undiagnosed.     

Different underlying pain mechanisms despite identical pain characteristics: a case report of a patient with spinal cord injury

Pain following spinal cord injury has been classified as nociceptive (musculoskeletal, visceral) or neuropathic (above, at, below level). There is no clear relation between the etiology and reported symptoms. Thus, due to different underlying mechanisms, the treatment is often ineffective. We report on a patient with spinal cord injury with neurological level of injury at T8 suffering from bilateral burning and prickling pain in the T9-11 dermatomes bilaterally (at-level pain), as well as diffusely in both legs from below the torso (below-level pain), accompanied by musculoskeletal low back pain. Bilateral comparison of quantitative sensory testing (QST) and skin biopsy revealed completely different findings in the dermatome T9 despite identical at-level pain characteristics. On the right side, QST revealed a normal sensory profile; the intraepidermal nerve fiber density (IENFD) was reduced, but not as severe as the contralateral side. On the left side there was a severe sensory loss with a stronger reduction of the IENDF, similar to the areas below the neurological level. These findings were significantly related to the treatment results. Pregabalin induced unilateral pain relief only in the area with remaining sensory function, whereas the left-sided at-level pain was unchanged. Thus, 2 different underlying mechanisms leading to bilaterally neuropathic pain with identical symptoms and with different treatment success were demonstrated in a single patient. The at-level pain in areas with remaining sensory function despite IENFD reduction could be relieved by pregabalin. Thus, in an individual case, QST may be helpful to better understand pain-generating mechanisms and to initiate successful treatment.     

MRI观察成人无骨折、脱位型颈髓损伤

目的 分析成人无骨折、脱位颈椎外伤合并颈脊髓损伤的MR表现及其临床意义.方法 收集该病患者38例,入院时均行颈椎X线、CT及MR检查,其中男32例,女6例,年龄24～62岁,平均(42.0±0.4)岁.结果 本组病例X线、CT及MR检查均未见颈椎骨折及脱位.脊髓MRI信号改变包括脊髓信号无改变4例,髓内水肿30例,髓内出血9例,脊髓软化或囊性变4例以及增强后有强化13例.其他MRI表现包括颈椎后纵韧带骨化或颈椎间盘退变或损伤后突出等,为脊髓受压迫的原因.结论 MRI可为无骨折、脱位型颈脊髓损伤患者的诊断与正确治疗提供依据.MRI无信号改变或仅有水肿表现者预后较好,髓内出血或者异常强化者预后较差.