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Investigating the effect of surgery time on improving the performance of fine movements of lower limbs in patients with traumatic spinal cord injury
Loghman Barani, Hossein Jafari Marandi , Masoud Zeinali, Hossein Safari,
Volume 81, Issue 2 (5-2023)
Abstract
Background: Traumatic Spinal Cord Injury (TSCI) is one of the catastrophic events, the rate of which has been growing compared to the past decades. Complications caused by TSCI have a wide spectrum and can range from complete paralysis to numbness of the limbs. Additional to the injury severity and disability of the patient, the recovery rate depends on the treatment strategies. Despite extensive efforts and research in this field, there are still few treatment options for TSCI patients. Controversial results have been reported, however, spinal cord decompression is the only certainty for the treatment of these patients. In the present study, patients with thoracic and lumbar fractures were undergone decompression, less and more than 24 hours, and the recovery rate (RR) was compared after 6 months.
Methods: In this study, patients with lumbar and thoracic fractures who were referred to the neurosurgery department of Ahvaz Golestan Hospital during May 2019 to December 2021 were included. Decompression was performed at the fracture level as a total and at the upper and lower levels of the fracture as a partial decompression. To evaluate fine motor movements, picking up a small object with toes and following a rectangular path were used. Also, the gross motor movements, upper and lower proximal and distal muscle forces were measured.
Results: 160 patients including 133 men (83.1%) and 16.9% women (27) with 36±12 years mean age were included. The most fracture location was lumbar (53.1%), followed by the thoracic (43.1%) and fractures in both regions (3.8%). The most injured  vertebras were L1 (27.5%) and T12 (18.8%). Six months later, 61.9% of patients had a good score for removing a small object with toe, of which 67.5% belonged to patients with<24 hours surgery (P=0.01). Also, RR for ability to follow a rectangle (P=0.017) and lower limit gross motor were significantly better in patients with<24 surgery (P=0.02). However, no significant difference was found between the two groups for improved sensations (P<0.05).
Conclusion: This study showed that decompression<24 hours in TSCI is associated with a significant improvement in lower fine movements.
 
Spontaneous rupture of accessory spleen 16 years after splenectomy: a case report
Seyed Hassan Seyed Sharifi , Mansoureh Baradaran,
Volume 81, Issue 2 (5-2023)
Abstract
Background: In most patients, the accessory spleen (AS) is small in size. However, in patients who have undergone splenectomy, AS may hypertrophy. This manuscript presents a rare case of spontaneous AS rupture nearly two decades after a prior splenectomy due to trauma. After searching multiple databases, only a few similar cases have been reported to date. In any acute abdominal patient with a history of previous splenectomy who presents with a mass in the anatomical location of the spleen, along with evidence of hematoma and free abdominal fluid on imaging, the possibility of AS rupture should be considered.
Case Presentation: In February 2022, a 36-year-old man who had undergone splenectomy due to trauma 16 years ago was referred to the emergency department at Imam Ali Hospital in Bojnord. He complained of sudden onset of severe abdominal pain, preferably in the upper region of the abdomen. The patient denied having any recent issues. Based on the patient's history and examination, at perforated stomach ulcer and pancreatitis were initially suspected. However, except for leukocytosis, no other abnormalities were observed in the laboratory tests. Ultrasound revealed a low-echo mass-like lesion in the anatomical location of the spleen. Another low-echo mass-like lesion, indicating a hematoma with abundant free fluid in the abdomen and pelvis, was also observed near the aforementioned mass. CT scan confirmed these findings. Open surgical and re splenectomy procedures were performed, and the diagnosis of spontaneous AS rupture was made based on clinical examination and imaging findings.
Conclusion: In any patient with a history of previous splenectomy who presents to the emergency room with diffuse and acute abdominal pain, even without recent trauma, if a mass-like lesion is observed in the anatomically suspicious location of the spleen in the left subphrenic space, along with other evidence of rupture such as hematoma/laceration and free fluid in the abdominal cavity, accessory spleen rupture should be considered as the main differential diagnosis.

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