Language：Japanese   Publisher：西日本整形・災害外科学会  

【はじめに】硬膜内に脱出した腰椎椎間板ヘルニアは稀な疾患である.発生リスクとしては長期罹患期間や,同部位の手術既往等が挙げられる.今回,MRIで硬膜内に脱出した腰椎椎間板ヘルニアを疑い手術加療を行った一例を経験したので報告する.【症例】41歳男性,177cm,130kg.19歳時にヘルニアを指摘.39歳時に腰痛・下肢痛が増悪,脊柱管狭窄も認めたため椎弓切除の上L4/5左・L5/S1両側ヘルニア摘出術を施行.術後症状軽快したが,2年後に症状再燃し脱力も出現.MRIでL4/5に巨大ヘルニアの再発があり,hawk-beak signを認め硬膜内への脱出を疑った.硬膜上の瘢痕を切除し,硬膜を切開してヘルニアを摘出.硬膜腹側にはヘルニア脱出孔が観察できた.術後症状は軽快した.【結語】通常のスクリーニング画像で硬膜内脱出ヘルニアを明確に診断することは困難であるが,特徴的な画像所見や病歴で鑑別診断に組み込むことが重要である.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

【はじめに】アルカプトン尿症は稀な先天性代謝異常症であり,色素沈着をきたした関節軟骨の変性により大関節に関節症性変化,脊椎に強直性変化が見られる.脊椎強直は特に胸腰椎に多く認め,頸椎ではまれであるが,今回我々は下位頸椎の強直により環軸椎の不安定性をきたし,脊髄症を発症したアルカプトン尿症の1例を経験したので報告する.【症例】65歳男性.歩行障害,四肢のしびれ,巧緻運動障害が出現し当科紹介.初診時の単純X線にて下位頸椎の強直及び環軸椎亜脱臼を認め,MRIではC1レベルでの脊髄の萎縮を認め,同レベルでの脊髄症と診断した.棘突起間スペーサーを用いた環軸椎関節の整復とMagerl+Brooks法による後方固定を施行し,脊髄症による症状は改善した.【結語】アルカプトン尿症において頸椎の強直性変化を認める症例は,環軸椎の不安定性をきたしやすく,脊髄症をきたす可能性を念頭に置くことが重要と思われた.(著者抄録)

Language：English   Publisher：Journal of Clinical Medicine  

Background: In patients with cervical spinal cord injury (SCI), we need to make accurate prognostic predictions in the acute phase for more effective rehabilitation. We hypothesized that a multivariate prognosis would be useful for patients with cervical SCI. Methods: We made two predictive models using Multiple Linear Regression (MLR) and Artificial Neural Networks (ANNs). We adopted MLR as a conventional predictive model. Both models were created using the same 20 clinical parameters of the acute phase data at the time of admission. The prediction results were classified by the ASIA Impairment Scale. The training data consisted of 60 cases, and prognosis prediction was performed for 20 future cases (test cohort). All patients were treated in the Spinal Injuries Center (SIC) in Fukuoka, Japan. Results: A total of 16 out of 20 cases were predictable. The correct answer rate of MLR was 31.3%, while the rate of ANNs was 75.0% (number of correct answers: 12). Conclusion: We were able to predict the prognosis of patients with cervical SCI from acute clinical data using ANNs. Performing effective rehabilitation based on this prediction will improve the patient’s quality of life after discharge. Although there is room for improvement, ANNs are useful as a prognostic tool for patients with cervical SCI.

DOI： 10.3390/jcm13010253

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Language：English   Publisher：Spine  

Study design: Retrospective study of prospectively collected data. Objective: To investigate the influence of cartilaginous endplates (CEs) in herniated discs on clinical symptoms and postoperative outcomes in patients with lumbar disc herniation (LDH) in different age groups. Summary of Background Data: LDH involving CEs, which are hard and less resorptive, is frequently observed with increasing age and appears to affect the natural course and clinical outcomes following discectomy. Methods: Overall, 239 patients who underwent microscopic discectomy were included. Main outcomes were evaluated using motor strength, visual analog scale (VAS) for back and leg pain, and Rolland-Morris Disability Questionnaire. The effects of CEs on clinical variables and postoperative outcomes were compared between two groups (<50 years and >50 years). Furthermore, we investigated the characteristics of CE avulsions in each group and examined the association between CE occupancy rate and clinical symptoms. Results: CEs were predominantly observed with increasing age and were more frequently detected in patients with Modic changes in both groups (p < 0.001). A higher proportion of LDH with a >20% occupancy rate was found in patients aged <50 years (p = 0.009) and was associated with a decrease in motor strength preoperatively (p = 0.007). Postoperative VAS score for low back pain (LBP) was higher in patients with CEs than in those without CEs in the >50-year-old group (p < 0.001). In multiple regression analysis, the presence of CEs was independently associated with residual LBP at 1 year postoperatively in older patients (β = 0.46, p < 0.001). Conclusion: Avulsion-type herniations in patients aged <50 years had a higher CE occupancy rate, which is a potential cause of preoperative motor weakness. Clinical outcomes following discectomy improved regardless of the presence of CEs, however, cartilaginous herniation in patients aged >50 years may affect residual LBP at 1 year.

DOI： 10.1097/BRS.0000000000005178

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PubMed

Language：English   Publisher：The Japanese Society for Spine Surgery and Related Research  

<p>Introduction: Intraoperative three-dimensional (3D) imaging guide technology, such as the O-arm surgical imaging system, is a beneficial tool in spinal surgery that provides real-time 3D images of a patient's spine. This study aims to determine the exposure dose from intraoperative O-arm imaging.</p><p>Methods: A consecutive retrospective review of all patients undergoing spinal surgery was conducted between June 2019 and August 2022. Demographic and operative data were collected from electronic medical records.</p><p>Results: Intraoperative O-arm imaging was conducted in 206 (12.9%) of 1599 patients, ranging from one to 4 scans per patient (1.17±0.43 scans). Single O-arm imaging enabled navigation of seven vertebrae in the cervical spine, seven in the thoracic spine, five in the thoracolumbar spine, and four in the lumbar spine on average. The number of O-arm shots per surgery was 1.15±0.36, 1.06±0.24, 1.61±0.7, and 1.07±0.25 for cervical, thoracic, thoracolumbar, and lumbar spinal cases, respectively. The exposure doses represented by dose length products in single O-arm imaging were 377±19 mGy-cm, 243±22 mGy-cm, 378±38 mGy-cm, and 258±11 mGy-cm for cervical, thoracic, thoracolumbar, and lumbar spine cases, respectively. We observed a weak positive correlation between the number of fused spinal levels and the exposure dose.</p><p>Conclusions: Intraoperative radiation exposure from O-arm imaging was lower than the national diagnostic reference levels in Japan established based on the International Commission on Radiological Protection publication, demonstrating its safety from the standpoint of radiological protection in most cases. In surgeries with a large range of fixations, such as corrective deformity surgery, the number of imaging sessions and the amount of intraoperative radiation exposure would increase, leading surgeons to pay attention to the risk of radiation in spinal surgery.</p>

DOI： 10.22603/ssrr.2023-0057

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CiNii Research

Language：English   Publisher：Frontiers in Immunology  

Background: Spinal cord injury (SCI) is a devastating disease that results in permanent paralysis. Currently, there is no effective treatment for SCI, and it is important to identify factors that can provide therapeutic intervention during the course of the disease. Zinc, an essential trace element, has attracted attention as a regulator of inflammatory responses. In this study, we investigated the effect of zinc status on the SCI pathology and whether or not zinc could be a potential therapeutic target. Methods: We created experimental mouse models with three different serum zinc concentration by changing the zinc content of the diet. After inducing contusion injury to the spinal cord of three mouse models, we assessed inflammation, apoptosis, demyelination, axonal regeneration, and the number of nuclear translocations of NF-κB in macrophages by using qPCR and immunostaining. In addition, macrophages in the injured spinal cord of these mouse models were isolated by flow cytometry, and their intracellular zinc concentration level and gene expression were examined. Functional recovery was assessed using the open field motor score, a foot print analysis, and a grid walk test. Statistical analysis was performed using Wilcoxon rank-sum test and ANOVA with the Tukey-Kramer test. Results: In macrophages after SCI, zinc deficiency promoted nuclear translocation of NF-κB, polarization to pro-inflammatory like phenotype and expression of pro-inflammatory cytokines. The inflammatory response exacerbated by zinc deficiency led to worsening motor function by inducing more apoptosis of oligodendrocytes and demyelination and inhibiting axonal regeneration in the lesion site compared to the normal zinc condition. Furthermore, zinc supplementation after SCI attenuated these zinc-deficiency-induced series of responses and improved motor function. Conclusion: We demonstrated that zinc affected axonal regeneration and motor functional recovery after SCI by negatively regulating NF-κB activity and the subsequent inflammatory response in macrophages. Our findings suggest that zinc supplementation after SCI may be a novel therapeutic strategy for SCI.

DOI： 10.3389/fimmu.2023.1290100

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Language：English   Publisher：(一社)日本脊椎脊髄病学会  

脊椎手術におけるO-アームイメージングからの術中放射線被曝線量を測定した。2019年6月～2022年8月にO-アームベース3Dナビゲーションシステム(本システム)による脊椎手術を受けた患者206例(男性123例、女性83例、平均65.7±17.9歳)を対象に、患者データ、手術データに関する診療録を後ろ向きに評価した。術中のスキャン回数は1回が173例(84%)、2回が31例(15%)、3回が1例(0.5%)、4回が1例(0.5%)であり、原疾患は脊椎変性疾患が158例(76.7%)、外傷が40例(19.4%)、その他(腫瘍、感染症、スクリュー置換)が8例(3.9%)であった。使用した本システムは全周性または円筒状の視野(FOV)を有するものであり、捕捉範囲は頸椎7個、胸椎7個、胸腰椎5個、腰椎4個となっていた。術中における平均O-アームショット数は頸椎が1.15±0.36、胸椎が1.06±0.24、胸腰椎が1.61±0.7、腰椎が1.07±0.25であり、スキャン回数は側彎症などの胸腰椎病変が有意に多かった。また、Dose Length Product(DLP)は頸椎が377±19mGy-cm、腰椎が243±22mGy-cm、胸腰椎が378±38mGy-cm、腰椎が258±11mGy-cmを示し、頸椎と胸腰椎における値が有意に高かった。固定脊椎レベル数とDLPとの間に弱い正の相関が認められたが、身長、体重、BMIとDLPとの間に有意な関連はみられなかった。手術における脊椎レベル、固定レベル数、O-アームイメージング回数が被曝線量に大きく影響することが示唆された。

Language：English   Publisher：Journal of Clinical Neuroscience  

Background: Meningiomas, although benign, often require complete resection due to their tendency for recurrence. However, dural reconstruction poses significant challenges, especially in the case of ventral meningiomas. While some reports have highlighted the usefulness of dural reconstruction using an artificial dura mater, no studies have yet confirmed dural canal enlargement through MRI post-surgically. This study aimed to assess the effectiveness of the Fenestrated Durotomy with Oversized Graft (FDOG) technique in cases of meningiomas and other intradural extramedullary tumors and evaluated dural canal dilation through MRI after using an artificial dura mater. Methods: This retrospective case series included 8 patients who underwent combined resection of intradural extramedullary tumors and dural repair using the FDOG technique. An artificial dura mater larger than that resected was inserted into the dural defect resulting from complete tumor resection on the ventral or lateral side of the spinal cord. The new dura mater was secured with a single dorsal suture. The dural incision was closed using watertight sutures following standard procedure. Measurement of the extent of dural canal enlargement was achieved via pre- and postoperative MRI scans. Results: None of the patients required additional treatments or lumbar drainage. All achieved independent ambulation without complications, and imaging tests indicated satisfactory dural expansion without signs of cerebrospinal fluid leakage. Conclusions: The proposed method for dural repair in cases involving large dural defects on the ventral or lateral side of the spinal cord was shown to be a straightforward and effective approach with minimal postoperative complications.

DOI： 10.1016/j.jocn.2023.09.003

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Language：English   Publisher：Journal of Spinal Cord Medicine  

Objectives: To elucidate the incidence and risk factors for pneumonia after acute traumatic cervical spinal cord injury (CSCI) Design: Retrospective cohort study. Setting: Spinal injuries center in Japan. Participants: Of 184 individuals who were admitted within 2 weeks after acute traumatic cervical spinal injuries, 167 individuals who met the criteria were included in this study. Interventions: The occurrence of pneumonia, degree of dysphagia using the Dysphagia Severity Scale, patient age, history of smoking, presence of tracheostomy, vital capacity, level of injury, and the American Spinal Injury Association Impairment Scale (AIS) 2 weeks after injury were assessed. Outcomes: Incidence of pneumonia were analyzed. Moreover, the risk factors of pneumonia were evaluated using logistic regression analysis. Results: From the 167 individuals who met the criteria, 30 individuals (18%) had pneumonia; in 26 (87%) of these individuals, pneumonia was aspiration related, defined as Dysphagia Severity Scale ≤ 4. The median occurrence of aspiration pneumonia was 11.5 days after injury. A logistic regression analysis revealed that severe AIS and severe Dysphagia Severity Scale scores were significant risk factors of pneumonia after CSCI. Conclusions: It was highly likely that the pneumonias following CSCI were related to aspiration based on the Dysphagia Severity Scale. In addition, most of the patients developed aspiration pneumonia within 1 month after injury. Aspiration and severe paralysis were significant risk factors for pneumonia. The treatment of dysphagia in the acute phase should be considered an important indicator to prevent pneumonia.

DOI： 10.1080/10790268.2022.2027323

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Language：Japanese   Publisher：西日本整形・災害外科学会  

【はじめに】頭蓋-上位頸椎不安定性を生じた化膿性破壊性頸椎炎に対して,良好な骨癒合と臨床成績が得られた2症例を経験したので報告する.【症例】症例1:85歳女性;切迫呼吸と高度四肢麻痺で緊急搬送された.画像検査にて咽後膿瘍による高度気管および食道の圧迫と上位頸椎骨破壊像を認めた.症例2:77歳男性;内服加療に抵抗性の頸部痛が主訴で搬送となった.画像検査にて咽後膿瘍と上位頸椎骨破壊像を認めた.【結果】2症例とも搬入当日にハローベスト外固定と抗生剤治療を開始した.症例1は,気管切開と切開排膿を施行し,呼吸状態は安定した.最終的に2症例ともハローベスト外固定と抗生剤にて感染鎮静化し,頭蓋-上位頸椎の安定化を認め,独歩退院となった.【考察】2症例とも初期診断と初期治療の遅れで咽後膿瘍と上位頸椎骨破壊像を認めた.MRIおよびCTによる積極的な画像診断が早期診断と早期治療に繋がると考えた.(著者抄録)

Language：English   Publisher：Stem Cells Translational Medicine  

Traumatic spinal cord injury (SCI) results in the loss of neurons, oligodendrocytes, and astrocytes. Present interventions for SCI include decompressive surgery, anti-inflammatory therapies, and rehabilitation programs. Nonetheless, these approaches do not offer regenerative solutions to replace the lost cells, fiber tracts, and circuits. Neural stem/progenitor cell (NPC) transplantation is a promising strategy that aims to encourage regeneration. However, NPC differentiation remains inconsistent, thus, contributing to suboptimal functional recovery. As such, we have previously engineered oligodendrogenically biased NPCs (oNPCs) and demonstrated their efficacy in a thoracic model of SCI. Since the majority of patients with SCI experience cervical injuries, our objective in the current study was to generate human induced pluripotent stem cell-derived oNPCs (hiPSC-oNPCs) and to characterize these cells in vitro and in vivo, utilizing a clinically relevant rodent model of cervical SCI. Following transplantation, the oNPCs engrafted, migrated to the rostral and caudal regions of the lesion, and demonstrated preferential differentiation toward oligodendrocytes. Histopathological evaluations revealed that oNPC transplantation facilitated tissue preservation while diminishing astrogliosis. Moreover, oNPC transplantation fostered remyelination of the spared tissue. Functional analyses indicated improved forelimb grip strength, gait, and locomotor function in the oNPC-Transplanted rats. Importantly, oNPC transplantation did not exacerbate neuropathic pain or induce tumor formation. In conclusion, these findings underscore the therapeutic potential of oNPCs in promoting functional recovery and histopathological improvements in cervical SCI. This evidence warrants further investigation to optimize and advance this promising cell-based therapeutic approach.

DOI： 10.1093/stcltm/szad044

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Publisher：三輪書店  

DOI： 10.11477/mf.5002202044

CiNii Research

Language：English   Publisher：(一社)日本脊椎脊髄病学会  

急性外傷性頸髄損傷(CSCI)にみられる栄養状態の経時的変化、低栄養に至る時期について検討した。急性外傷性CSCI患者106例(男性88例、女性18例、中央値66歳)を対象に単施設後ろ向きコホート研究を行い、予後栄養指数(PNI)、controlling nutritional status(CONUT)スコア、米国脊髄損傷学会障害度スコア(AIS)、嚥下障害重症度を入院時と1、2、3ヵ月後に測定した。受傷3日後にAISカテゴリーがA、B、Cと判定された患者ではカテゴリーDの患者と比較して低栄養を呈する割合が有意に高く、麻痺が軽度にとどまる場合は栄養状態が良好であることが示された。PNIとCONUTをもとに栄養状態を評価すると、受傷1ヵ月後と2ヵ月後の間にスコアは有意に改善していたが、入院時と1ヵ月後との間に有意な変化はみられず、CONUTスコアのみ2ヵ月後と3ヵ月後の間に有意な改善がみられた。栄養状態と嚥下障害との間に有意な相関が認められ、PNIの方がCONUTより相関度が高値を示していた。CSCI患者の栄養状態は受傷後1ヵ月を経過してから改善がみられるものの、受傷後早期に重度麻痺を呈する患者では低栄養に留意する必要があると考えられた。

Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

はじめに:外傷後脊髄空洞症に対する,くも膜下腔-くも膜下腔バイパス手術(Subarachnoid-subarachnoid bypass:S-S bypass)の髄液還流改善による脊髄空洞縮小効果はすでに良好な成績が報告されている.我々は脊髄外傷以外の原因で生じる脊髄癒着性くも膜炎に対してもS-S bypass手術を行ったので,その効果を検討しS-S bypass手術の適応について考察した.対象と方法:くも膜病変により脊髄空洞症を生じた病態に対してS-S bypass手術を行った45例(外傷後脊髄空洞症28例,Arachnoid web 6例,それら以外の癒着性くも膜炎11例)を対象とした.臨床症状を,改善,不変,悪化の3段階で評価した.また髄液還流改善効果をMRIにおける空洞縮小の有無で評価した.結果:45例中36例(82%)で空洞縮小が認められた.臨床症状は,32例(71%)が改善,7例(16%)が不変,6例(13%)が悪化となっていた.結語:S-S bypass手術は大多数の症例で空洞の縮小を認めており髄液還流障害を改善させる効果があると考えられた.(著者抄録)

Publisher：Spine Surgery and Related Research  

Introduction: This retrospective cohort study aimed to examine the nutritional time course and elucidate the critical period of undernutrition following acute traumatic cervical spinal cord injury (CSCI). Methods: The study was performed at a single facility that treated spinal cord injuries. We examined individuals with acute traumatic CSCI admitted to our hospital within 3 days of injury. Both prognostic nutritional index (PNI) and controlling nutritional status (CONUT) scores, which objectively reflect nutritional and immunological conditions, were assessed at admission and 1, 2, and 3 months after the injury. The American Spinal Injury Association impairment scale (AIS) categorizations and severity of dysphagia were evaluated at these time points. Results: A total of 106 patients with CSCI were evaluated consecutively for 3 months after injury. Individuals with AIS categorizations of A, B, or C at 3 days after injury were significantly more undernourished than those with an AIS categorization of D at 3 months after injury, indicating that individuals with mild paresis better maintained their nutritional condition after injury. Nutritional conditions, as assessed by both PNI and CONUT scores, improved significantly between 1 and 2 months after injury, whereas no significant differences were found between admission and 1 month after injury. Nutritional status and dysphagia were significantly correlated at each time point (p<0.001), indicating that swallowing dysfunction is an important factor associated with malnutrition. Conclusions: Nutritional conditions showed significant gradual improvements from 1 month after the injury. We must pay attention to undernutrition, which is associated with dysphagia, especially in individuals with severe paralysis during the acute phase following injury.

DOI： 10.22603/ssrr.2022-0158

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Publisher：Journal of Spinal Cord Medicine  

Objective: To investigate the usefulness of the combination of neurological findings and magnetic resonance imaging (MRI) as a prognostic predictor in patients with motor complete cervical spinal cord injury (CSCI) in the acute phase. Design: A cross-sectional analysis Setting: Department of Orthopaedic Surgery, Spinal Injuries Center Participants/Methods: Forty-two patients with an initial diagnosis of motor complete CSCI (AIS A, n = 29; AIS B, n = 13) within 72 h after injury were classified into the recovery group (Group R) and the non-recovery group (Group N), based on the presence or absence of motor recovery (conversion from AIS A/B to C/D) at three months after injury, respectively. The Neurological Level of Injury (NLI) at the initial diagnosis was investigated and the presumptive primary injured segment of the spinal cord was inferred from MRI performed at the initial diagnosis. We investigated whether or not the difference between the presumptive primary injured segment and the NLI exceeded one segment. The presence of a difference between the presumptive primary injured segment and the NLI was compared between Groups R and N. Results: The number of cases with the differences between the presumptive primary injured segment and the NLI was significantly higher in Group N than in Group R. Conclusion: The presence of differences between the presumptive primary injured segment and the NLI might be a poor improving prognostic predictor for motor complete CSCI. The NLI may be useful for predicting the recovery potential of patients with motor complete CSCI when combined with the MRI findings.

DOI： 10.1080/10790268.2021.1903139

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Language：Japanese   Publisher：(公財)上原記念生命科学財団  

Language：Japanese   Publisher：西日本整形・災害外科学会  

脆弱性仙骨骨折患者が下肢痛を訴えることがしばしばあるが,転倒歴がない例や腰部脊柱管狭窄症の所見がある例では見落とされることがある.神経根症状様の下肢痛を呈した脆弱性仙骨骨折症例15例を検討した.骨折型はDenis分類zone IIまたはzone IIIであり,L5神経根症状様の下肢痛を有する症例ではいずれも骨折線が仙骨翼に及んでいた.腰部脊柱管狭窄所見は10例に存在し,下肢痛の原因としての仙骨骨折の見落としをしないよう注意が必要である.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

【はじめに】骨傷のない外傷性環軸椎後方脱臼は非常に珍しい.今回,非骨傷性外傷性環軸椎後方脱臼に非骨傷性中下位頸髄損傷を合併した症例を経験したので報告する.【症例】74歳男性.50cm程の階段より顔から前方へ転落して受傷.AIS D,改良Frankel分類C2/C2の四肢麻痺と診断した.画像診断にてCT上,環軸椎後方脱臼を認めたが,骨傷は認めなかった.MRIではC3/4高位に髄内異常信号変化を認めるも,環軸椎レベルでの信号変化は認めなかった.ハローリング外固定にて,最大8kgで24時間直達牽引を行うも,整復位は得られず,透視下にて牽引整復を施行した.しかし,その後再脱臼を来したため,全身麻酔下仰臥位にて徒手整復を行い,C1/2後方固定術を施行した.術後8週目で独歩可能となるまで神経学的回復を認め,自宅退院となった.【考察】既存の歯突起後方偽腫瘍に非骨傷性外傷性環軸椎後方脱臼と非骨傷性頸髄損傷を来した一例を経験した.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

【はじめに】成人脊柱変形手術では矢状面に加え冠状面バランス不良の是正が重要である.特にoblique take-offは冠状面バランス不良遺残の原因となるため注意を要する.Lenkeらが報告したkickstand rod(KR)法は,冠状面の傾斜側にロッドを追加し腸骨稜から胸腰椎移行部に向け自転車のスタンドの様に支持・矯正力をかける手技である.KRは冠状面バランス不良を是正し全体の剛性を増強することでoblique take-offの矯正や術後の矯正損失予防に効果があると報告されている.今回,成人脊柱変形患者にKRを併用し変形矯正固定を行ったので報告する.【症例】59歳女性.腰痛,左下肢痛を主訴に受診.腰椎変性後側彎症と診断し,KRを併用し変形矯正固定術を行った.手術にてC7-CSVLは左69mmから0mmと改善.肩バランス不良も無く良好な冠状面バランスが獲得でき,術後半年でも維持されていた.【結語】本症例ではKRを併用し良好な冠状面バランスが獲得・維持できた.(著者抄録)

Language：English   Publisher：Medicine (United States)  

Rationale: Traumatic cervical spinal cord injury (SCI) is a devastating condition leading to respiratory failure that requires permanent mechanical ventilation, which is the main driver of increased medical costs. There is a great demand for establishing therapeutic interventions to treat respiratory dysfunction following severe cervical SCI. Patient concerns and diagnosis: We present a 24-year-old man who sustained a cervical displaced C2-C3 fracture with SCI due to a traffic accident. As the patient presented with tetraplegia and difficulty in spontaneous breathing following injury, he was immediately intubated and placed on a ventilator with cervical external fixation by halo orthosis. The patient then underwent open reduction and posterior fusion of the cervical spine 3 weeks after injury. Although the patient showed significant motor recovery of the upper and lower limbs over time, only a slight improvement in lung capacity was observed. Interventions and outcomes: At 1.5 years after injury, a diaphragmatic pacing stimulator was surgically implanted to support the patient's respiratory function. The mechanical ventilator support was successfully withdrawn from the patient 14 weeks after implantation. We observed that both the vital capacity and tidal volume of the patient were significantly promoted following implantation. The patient finally returned to daily life without any mechanical support. Lessons: The findings of this report suggest that diaphragmatic pacing implantation could be a promising treatment for improving respiratory function after severe cervical SCI. To our knowledge, this is the first SCI patient treated with a diaphragm pacing implantation covered by official medical insurance in Japan.

DOI： 10.1097/MD.0000000000029719

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