Clinical Neuroscience

[Relation of acute and long-therm care of the spinal-cord-injured patients in up-to-date management]


JANUARY 20, 1993

Clinical Neuroscience - 1993;46(01-02)

[The acute emergency management of the spinal-cord-injured patients is one of the most important steps in the long-lasting complex treatment which has great significance for the final results. The method of primary neurosurgical operation must be chosen with regard to the special aspects of subsequent rehabilitation. All conditions of emergency surgery have to be assured during the first 6-8 hours. According to the experiences of the last two decades the problems of the management of spinal-cord-injured patients originated in the shortage of financial sources, theoretical concepts and organization, lack of interest and scientific information. Even now there is no spinal-cord-injured center in Hungary which would provide for the complex management including primary neurosurgical treatment and all details up till the end of paraplegic rehabilitation. Primary treatment (either operative or conservative) and rehabilitation are performed in separate departments. Though there is a significant development in emergency spinal surgery during the last years (and it is a pity this can not be seen in rehabilitation in Hungary), it is still an important demand that emergency surgery should be performed with rehabilitation aspects. Until we have no proper financial conditions to organize spinal centers for both emergency and rehabilitation treatment, our most important task is to develop a unified rehabilitational view of all specialists involved in the complex treatment of spine-injured patients.]


  1. MÁV Kórház - Budapest, Mozgásszervi Rehabilitációs Osztály
  2. Országos Traumatológiai Intézet, Idegsebészeti Osztály, Budapest
  3. Országos Orvosi Rehabilitációs Intézet, Budapest



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Clinical Neuroscience

[Acute neurosurgical management of severe thoraco-lumbar spinal injuries]


[Authors show their experiences with up-to-date segmental stabilization methods in the acute neurosurgical management of severe thoraco-lumbar spinal injuries. Among the 134 acute operations during 5 years with at least 1 year follow-up 81 were performed by Fixateur Interne (AO-ASIF, W. Dick), and 53 by angle-stable posterior plate-fixation (Steffee or Eger plates). Reduction, decompression and stabilization were achieved by these instrumentations. Results are evaluated from the points of view of neurological recovery, bony union, restoration of patients comfort and complications. Also the principles of modern management of spine-injured patients, developed through a long evolution in the last decade, are reviewed. It is stated that both segmental stabilization methods were used as routine, and they were suitable for the treatment of the most of severe thoraco-lumbar spinal injuries. Results of these methods are much better than those of the long-rod systems, but on condition that emergency neurosurgical treatment should be done in the first 6-8 hours together with early skilled and competent rehabilitation in a well trained center.]

Clinical Neuroscience

[Tethered cord syndrome in adults]


[The tethered cord syndrome is resulted from the abnormally low position and traction of the conus medullaris in the lumbosacral region, that leads to progressive dysfunction of the caudal spinal segments. It originates from various ectodermal abnormalities, all due to errors of embryonic development in the 3rd-4th weeks. The disorder is manifested by progressive motor, sensory and trophic deficits in the legs and by incontinence. The adult onset is rare. The MRI is the most important procedure for pathoanatomic evaluation. The surgical aim is to stop progressivity and to cure the reversible deficits. We report our six cases and present the data of the literature concluding the caracteristics, the surgical indications and outcome of the tethered cord syndrome in adults.]

Clinical Neuroscience

[Operative treatment of craniocervical instabilities caused by rheumatoid arthritis]

TURÓCZY László, KENÉZ József, VERES Róbert, NAGY Aladár, PÁSZTOR Emil

[We have investigated and operatively treated 30 patients with craniocervical instabilities caused by rheumatoid arthritis. The evaluation of this patient-material seems to be important, because the indications of operations in the different stages of the disease are not completely clear, according to our knowledge. The atlanto-axial instabilities at the beginning stage, when the serious neurologic signs are absent, can be treated with low risk dorsal stabilization, while we believe the advanced instabilities need combined neurosurgical approach for successful treatment. We must emphasize the importance of detailed early diagnostics, and the prevention in neurosurgical approaches, in accordance of the opinions, expressed in different contributions in the literature, dealing with the subject. In 20 cases we had to perform combined surgical interventions, and only in 10 cases, the simple dorsal fixation proved to be satisfactory, which fact shows, that we got patients mainly in more serious stages. We detected a new sign ("ghost tumor") in the natural course of the disease.]

Clinical Neuroscience

[Our experiences in the conservative treatment of the compression fractures of the thoracolumbar spine]

URBÁN Ferenc, TAKÁCS Ferenc

[The authors at the DOTE Department of Traumatology made follow-up examinations of 136 patients treated for compression fractures of the thoracolumbar spine. 63 patients (46,3%) were treated with plaster corset, 73 patients (53,7%) with modified Magnus method. They compared the two methods of treatment for their possibilities and effectiveness. They used plaster corset after reposition in females under 55 years of age and in males under 60 years of age, if the patients' physical and general condition were suitable and the compression was more than 10 degrees. 47,9% of the patients treated functionally recovered well and 31,5% were in a satisfactory state. And 47,6% of the patients treated with plaster corset recovered well and 46,0% recovered satisfactorily. While in the first group i.e.those treated functionally, 17,8% of the patients had severe pain, only 6,4% of the patients treated with corset had similar pain. The authors ascertain that as the anatomical reposition of the fractures is not possible indefinitely, the insertion of the plaster corset when the compression exceeds 10–15 degrees is more suitable. When the deformity decreases, the subjective complaints of the patients decrease too. In the case of small compression, functional treatment is recommended and the patient must lie in bed to alleviate the pain. Both the methods used under appropriate conditions are useful and complement each other. ]

Clinical Neuroscience

[Lumbar small joint instability and the low back pain]

SIKÓ Ildikó, ZÁBORSZKY Zoltán, KOVÁCS Zsombor, VAJDA Olga

[Lumbar facet arthopathy is an important cause of the low back pain. Observation of history, clinical evaluation and paraclinical investigation suggest, that as cause of low-back pain, among others, the lumbar small joint instability is present. The special symptomatology, intra-articular facet block and the CT scan in Twist-position" can confirm facet joint disease. Authors report on their experiences gained in 20 cases. The method of selection and the earliest results are described.]

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Clinical Neuroscience

[Rehabilitation possibilities and results after neurosurgical intervention of brain tumors ]

DÉNES Zoltán, TARJÁNYI Szilvia, NAGY Helga

[Objectives - Authors examined the rehabilitation possi­bi­lities, necessities, and results of patients after operation with brain tumor, and report their experiences. Method - Retrospective, descriptive study at the Brain Injury Rehabilitation Unit, in National Institute for Medical Rehabilitation. Patients - Patients were admitted consecutively after rehabilitation consultation, from different hospitals, following surgical intervention of brain tumors, between 01 January 2001 and 31 December 2016. Patients participated in a postacute inpatient rehabilitation program, in multidisciplinary team-work, leaded by Physical and Rehabilitation Medicine specialist included the following activities: rehabilitation nursing, physical, occupational, speech, psychological and neuropsychological therapy. Results - At the rehabilitation unit, in the sixteen-year period 84 patients were treated after operation with brain tumor. Patients arrived at the unit after an average of 41 days to the time of the surgical intervention (range: 10-139 days), and the mean length of rehabilitation stay was 49 days (range: 2-193 days). The mean age of patients was 58 years (20-91), who were 34 men and 50 women. The main symptoms were hemiparesis (64), cognitive problems (26), dysphagia (23), aphasia (16), ataxia (15), tetraparesis (5), and paraparesis (1). The mean Barthel Index at the time of admission was 35 points, whereas this value was 75 points at discharge. After the inpatient rehabilitation, 73 patients improved functionally, the status of 9 patients did not show clinically relevant changes, and 2 patients deteriorated. During the rehabilitation 10 patients required urgent interhospital transfer to brain surgery units, 9 patients continued their oncological treatment, two patients continued rehabilitation treatment at another rehabilitation unit, and after rehabilitation 73 patients were discharged to their homes. Conclusions - Inpatient rehabilitation treatment could be necessary after operation of patients with brain tumor especially when functional disorders (disability) are present. Consultation is obligatory among the neurosurgeon, rehabilitation physician and the patient to set realistic rehabilitation goals and determine place and method of rehabilitation treatment, but even at malignancies cooperation with oncological specialist also needed. Authors’ experience shows benefits of multidisciplinary rehabilitation for patients after brain tumor surgery. ]

Clinical Neuroscience

The effects of the level of spinal cord injury on life satisfaction and disability

GULSAH Karatas, NESLIHAN Metli, ELIF Yalcin, RAMAZAN Gündüz, FATIH Karatas, MÜFIT Akyuz

Introduction - Spinal Cord Injury (SCI) may often lead to significant disability in affected individuals and reduce life satisfaction. Herein we aimed to investigate the effects of the level of injury on disability and life satisfaction as well as the relation between life satisfaction and disability. Methods - Patients with at least one-year history of SCI were included. Demographic-clinical data of patients were recorded. The Craig Handicap Assessment and Reporting Technique-Short Form (CHART-SF) was used for quantifying the degree of patients’ disability. Life satisfaction was assessed by the Satisfaction with Life Scale (SWLS). Results - Of the 76 patients, 21 (27.6%) were tetraplegic and 55 (72.4%) were paraplegic. SWLS was found to be similar in tetraplegic vs. paraplegic patients (P=0.59), whereas CHART parameters such as physical independence, mobility, occupation, and total CHART value were significantly higher in paraplegic patients (P=0.04, P=0.04, P=0.001 and P=0.01, respectively). Social integration was found similarly high in both groups. There was a positive correlation between elapsed time after the injury and CHART physical independence, occupation and the level of economic sufficiency (P<0.01, P<0.01, P=0.01). Excluding the economic sufficiency (P=0.02), there was not any other association between the rest of CHART parameters and SWLS. Conclusions - According to our findings, although the level of injury seems to be influential on disability, it seems to have no significant effect on life satisfaction. Since the only thing that positively affects life satisfaction is economic sufficiency, more emphasis should be placed on regulations that increase the return to work in patients.

Clinical Neuroscience

[The complex intensive care and rehabilitation of a quadriplegic patient using a diaphragm pacemaker]

FODOR Gábor, GARTNER Béla, KECSKÉS Gabriella

[A 21 year female polytraumatized patient was admitted to our unit after a serious motorbike accident. We carried out CT imaging, which confirmed the fracture of the C-II vertebra and compression of spinal cord. Futhermore, the diagnostic investigations detected the compound and comminuted fracture of the left humerus and femur; the sacrum and the pubic bones were broken as well. After the stabilization of the cervical vertebra, a tracheotomy and the fixation of her limbs were performed. She spent 1.5 years in our unit. Meanwhile we tried to fix all the medical problems related to tetraplegia and respiratory insufficiency. As part of this process she underwent an electrophysiological examination in Uppsala (Sweden) and a diaphragm pacemaker was implanted. Our main goal was to reach the fully available quality of life. It is worth making this case familiar in a wider range of public as it could be an excellent example for the close collaboration of medical and non-medical fields.]

Clinical Neuroscience

[New opportunities in neuro-rehabilitation: Robot mediated therapy in conditons post central nervous system impairments]

FAZEKAS Gábor, TAVASZI Ibolya, TÓTH András

[Decreasing the often-seen multiple disabilities as a consequence of central nervous system impairments requires broadening of the tools of rehabilitation. A promising opportunity for this purpose is the application of physiotherapy robots. The development of such devices goes back a quarter of century. Nowadays several robots are commercially available both for supporting upper and lower limb therapy. The aim is never to replace the therapists, but rather to support and supplement their work. It is worthwhile applying these devices for goal-oriented exercises in high repetition, which one physically fatiguing for the therapist or for the correction of functional movement by various strategies. Robot mediated therapy is also useful for motivation of the patient and making the rehabilitation programme more versatile. Robots can be used for assessment of the neuromotor status as well. Several clinical studies have been executed in this field, all over the world. Meta-analyses based on randomized, controlled trials show that supplementing the traditional physiotherapy with a robot-mediated component presents advantage for the patients. Further studies are necessary to clarify which modality and intensity of the exercises, in which group of patients, in which stage lead to the expected outcome.]

Clinical Neuroscience

[Results of intrathecal baclofen therapy on spasticity in patients with brain injury]

DÉNES Zoltán, KLAUBER András, BOTH Béla, ERÕSS Loránd

[Objectives - To evaluate the results of intrathecal baclofen (ITB) therapy on the spasticity in patients with brain injury. Method - Retrospective study in Brain Injury Rehabilitation Unit between January 2001 and December 2010. Results - During the last ten years, in our unit 13 patients were involved into ITB therapy on severe spasticity, after brain injury, while more than 100 Baclofen pumps were implantated in Hungary with Hungary with coordination of the Multidisciplinary Team. ITB therapy was indicated in severe spasticity developed after seven cases of traumatic brain injuries, five cases of strokes and one case of anoxic brain injury. The mean age of patients was 26 years (18- 52). At the time of pump implantation three patients were in vegetative state. The shortest period elapsed between the brain injury and pump implantation was three months and the longest period was nine years, mean 15 months. Baclofen pump had to be changed in six cases after six years, and was removed in three cases due to decreasing spasticity. Catheter revision was performed in two cases due to flow problem. We had no complication in association with ITB therapy. Conclusions - Intrathecal baclofen therapy seems to be an effective and safe treatment in patients with severe spasticity of cerebral origin. We suggest team (neurosurgeon and rehabilitation professionals) decision in a spasticity center before involving the patient into ITB therapy, and follow up in the rehabilitation unit. The severity of spasticity as a consequence of brain injury can change during years and it is necessery to follow it with dosage and dynamics of baclofen therapy. Baclofen pump removal is suggested if the ITB therapy is further not reasonable.]