Browsing by Author "Guest, James D."

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Acute penetrating injury of the spinal cord by a wooden spike with delayed surgery: a case report
    (Wolters Kluwer, 2023) Guest, James D.; Luo, Zhuojing; Liu, Yansheng; Gao, Hongkun; Wang, Dianchun; Xu, Xiao-Ming; Zhu, Hui; Neurology, School of Medicine
    Rarely, penetrating injuries to the spinal cord result from wooden objects, creating unique challenges to mitigate neurological injury and high rates of infection and foreign body reactions. We report a man who sustained a penetrating cervical spinal cord injury from a sharpened stick. While initially tetraparetic, he rapidly recovered function. The risks of neurological deterioration during surgical removal made the patient reluctant to consent to surgery despite the impalement of the spinal cord. A repeat MRI on day 3 showed an extension of edema indicating progressive inflammation. On the 7th day after injury, fever and paresthesias occurred with a large increase in serum inflammatory indicators, and the patient agreed to undergo surgical removal of the wooden object. We discuss the management nuances related to wood, the longitudinal evolution of MRI findings, infection risk, surgical risk mitigation and technique, an inflammatory marker profile, long-term recovery, and the surprisingly minimal neurological deficits associated with low-velocity midline spinal cord injuries. The patient had an excellent clinical outcome. The main lessons are that a wooden penetrating central nervous system injury has a high risk for infection, and that surgical removal from the spinal cord should be performed soon after injury and under direct visualization.
  • Thumbnail Image
    Item
    Surgical intervention combined with weight-bearing walking training promotes recovery in patients with chronic spinal cord injury: a randomized controlled study
    (Wolters Kluwer, 2024) Zhu, Hui; Guest, James D.; Dunlop, Sarah; Xie, Jia-Xin; Gao, Sujuan; Luo, Zhuojing; Springer, Joe E.; Wu, Wutian; Young, Wise; Poon, Wai Sang; Liu, Song; Gao, Hongkun; Yu, Tao; Wang, Dianchun; Zhou, Libing; Wu, Shengping; Zhong, Lei; Niu, Fang; Wang, Xiaomei; Liu, Yansheng; So, Kwok-Fai; Xu, Xiao-Ming; Neurological Surgery, School of Medicine
    For patients with chronic spinal cord injury, the conventional treatment is rehabilitation and treatment of spinal cord injury complications such as urinary tract infection, pressure sores, osteoporosis, and deep vein thrombosis. Surgery is rarely performed on spinal cord injury in the chronic phase, and few treatments have been proven effective in chronic spinal cord injury patients. Development of effective therapies for chronic spinal cord injury patients is needed. We conducted a randomized controlled clinical trial in patients with chronic complete thoracic spinal cord injury to compare intensive rehabilitation (weight-bearing walking training) alone with surgical intervention plus intensive rehabilitation. This clinical trial was registered at ClinicalTrials.gov (NCT02663310). The goal of surgical intervention was spinal cord detethering, restoration of cerebrospinal fluid flow, and elimination of residual spinal cord compression. We found that surgical intervention plus weight-bearing walking training was associated with a higher incidence of American Spinal Injury Association Impairment Scale improvement, reduced spasticity, and more rapid bowel and bladder functional recovery than weight-bearing walking training alone. Overall, the surgical procedures and intensive rehabilitation were safe. American Spinal Injury Association Impairment Scale improvement was more common in T7–T11 injuries than in T2–T6 injuries. Surgery combined with rehabilitation appears to have a role in treatment of chronic spinal cord injury patients.