Journal of Trauma and Injury

Case Reports

Detection of pharyngeal perforation during fiberoptic endoscopic evaluation of swallowing in a person with cervical spinal cord injury in the intensive care unit: a case report: Min Soo Choi, Sang Hun Han, Yong Beom Shin, Myung Hun Jang; J Trauma Inj. 2022;35(Suppl 1):S40-S45. Published online July 22, 2022; DOI: https://doi.org/10.20408/jti.2022.0016

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Abstract PDF: Endotracheal tube insertion and mechanical ventilation are indicated in spinal cord injury patients; however, dysphagia can occur after extubation. The resultant complications of dysphagia may increase the length of hospital stay and mortality. Therefore, dysphagia should be evaluated after extubation. This case report introduces a rare case of finding pharyngeal perforation during the fiberoptic endoscopic evaluation of swallowing (FEES) in patients with cervical spine injuries in the intensive care unit. A 71-year-old male patient met with a road traffic accident. The patient underwent C3–4 posterior fusion and C3–4 anterior cervical discectomy and fusion. After successful extubation, the patient underwent FEES to assess swallowing function. During FEES, the metallic plate was found to be exposed through mucosal erosion, and swelling was observed at the surgical site at the hypopharynx. The nasogastric tube was removed to prevent secondary damage and infection at the operation site and the patient was received conservative therapy. The FEES endoscope machine is portable so it can be easily applied at the bedside to intensive care unit patients. In addition, FEES allows the identification of anatomical abnormalities of the oropharynx and abnormalities of vocal cord. Thus, it is recommended to do FEES to check anatomical abnormalities as well as dysphagia in patients in the intensive care unit.; Summary

Delayed Post-Traumatic Spinal Cord Infarction with Quadriplegia: A Case Report: Tae Hoon Kim; J Trauma Inj. 2021;34(4):279-283. Published online August 10, 2021; DOI: https://doi.org/10.20408/jti.2021.0004

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Abstract PDF: Traumatic spinal cord infarction is a rare condition that causes serious paralysis. The regulation of spinal cord blood flow in injured spinal cords remains unknown. Spinal cord infarction or ischemia has been reported after cardiovascular interventions, scoliosis correction, or profound hypotension. In this case, a 52-year-old man revisited the emergency center with motor and sensory abnormalities in all four extremities 56 hours after a motor vehicle collision. Despite the clinical presentation and imaging examination, there were no specific findings on the patient’s first visit to the trauma center. Cervical spine computed tomography angiography showed a narrow vertebral artery, and diffusion-weighted imaging revealed spinal cord infarction from C3 to C5 with high signal intensity. It should be kept in mind that delayed-onset spinal cord infarction may occur in minor or major trauma patients as a result of head and neck injuries.; Summary

Original Article

Comparison of Magnetic Resonance Imaging and Operation Waiting Times in Patients Having Traumatic Cervical Spinal Cord Injury; with or without Bony Lesions: Jeong Heo, Woo-Kie Min, Chang-Wug Oh, Joon-Woo Kim, Kyeong-hyeon Park, Il Seo, Eung-Kyoo Park; J Trauma Inj. 2019;32(2):80-85. Published online June 30, 2019; DOI: https://doi.org/10.20408/jti.2019.004

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Abstract PDF: Purpose
To compare the time intervals to magnetic resonance imaging (MRI) and surgical treatment in patients having traumatic cervical spinal cord injury (SCI) with and without bony lesions.
Methods
Retrospectively analyzed adult patients visited Kyungpook National University Hospital and underwent surgical treatment for cervical SCI within 24 hours. The patients who were suspected of having cervical SCI underwent plain radiography and computed tomography (CT) upon arrival. After the initial evaluation, we evaluated the MRI findings to determine surgical treatment. Waiting times for MRI and surgery were evaluated.
Results
Thirty-four patients were included. Patients’ mean age was 57 (range, 23-80) years. Patients with definite bony lesions were classified into group A, and 10 cases were identified (fracture-dislocation, seven; fracture alone, three). Patients without bony lesions were classified into group B, and 24 cases were identified (ossification of the posterior longitudinal ligament, 16; cervical spondylotic myelopathy, eight). Mean intervals between emergency room arrival and start of MRI were 93.60 (±60.08) minutes in group A and 313.75 (±264.89) minutes in group B, and the interval was significantly shorter in group A than in group B (p=0.01). The mean times to surgery were 248.4 (±76.03) minutes in group A and 560.5 (±372.56) minutes in group B, and the difference was statistically significant (p=0.001). The American Spinal Injury Association scale at the time of arrival showed that group A had a relatively severe neurologic deficit compared with group B (p=0.046). There was no statistical significance, but it seems to be good neurological recovery, if we start treatment sooner among patients treated within 24 hours (p=0.198).
Conclusions
If fracture or dislocation is detected by CT, cervical SCI can be easily predicted resulting in MRI and surgical treatment being performed more rapidly. Additionally, fracture or dislocation tends to cause more severe neurological damage, so it is assumed that rapid diagnosis and treatment are possible.; Summary

Review Article

Current Concept and Future of the Management of Spinal Cord Injury: A Systematic Review: Il Choi, Jin Gyeong Ha, Sang Ryong Jeon; J Trauma Inj. 2013;26(3):63-73.

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Abstract PDF: Spinal cord injury (SCI) is a serious condition associated with social and familial burden, as well as significant neurologic deficit. Despite the many advances in the treatment of spinal cord injury, a fundamental treatment for neurologic functional recovery has not yet been developed. In this article, we review two directions of development for spinal cord injury treatment: neuroprotective pharmacological agents and axon-regenerating cell therapy. We expect developments in these two to lead to improve functional recovery in patients with spinal cord injuries and to reduce burdens on society, as well as the patients' families.; Summary

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