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303 Spinal holocord epidural abscess evacuated with double thoracic interval laminectomy - A rare case report with literature review Dr Kaustubh Ahuja1, Dr. Laxmana Das1, Dr Aakriti Jain1, Dr. Pankaj Kandwal1, Dr. Shobha Arora1 1All India Institute Of Medical Sciences, Rishikesh Introduction: Spinal epidural abscess is a rare but lethal condition. Its reported incidence ranges from 0.2- 1.2% per 10000 hospital admissions. Holocord Spinal Epidural Space(HSEA) is an even rarer condition associated with high morbidity and mortality.Management for HSEA is controversial and generally includes a thorough surgical decompression with targeted antibiotic therapy. Despite the advances in radiology, antibiotic therapy and surgical techniques mortality rate associated with HSEA is around 15%. This case report describes a novel technique of keystone skip laminectomies at two sites in dorsal spine and surgical decompression with the help of infant feeding tube in a case of HSEA. Methods and Results An 18-year-old previously healthy male presented with high grade fever and low back ache (VAS: 9/10) for 2 weeks and loss of bowel and bladder control for 4 days to our emergency department. There was no history of trauma or any history of drug abuse .Muscle power in bilateral upper limb and lower limb was MRC grade 5. Sensations were intact and reflexes were universally mute. Over the next 24 hours his neurology deteriorated rapidly with complete loss of muscle power in both upper and lower limbs and sensory deficit upto 60 percent in all limbs. MRI showed hyperintense epidural collection extending from C2 to sacral neural foramina with peripheral post contrast enhancement causing anterior displacement of cord. Patient was planned for emergent laminectomy at T2 and T10 level for pus evacuation by suction and irrigation using an infant feeding tube and complete decompression of the spinal canal. Post operatively patient started on intravenous antibiotics for 4 weeks based culture report. Patient was mobilized with the help of a walker and was discharged 4 weeks after surgery with motor power of MRC grade 4 in all four limbs. At the end of 10 months patient recovered full motor power in all four limbs Conclusion: This case presented here is peculiar because of a number of features. Firstly, no risk factors could be identified. The patient was a young adult with no significant history that would predispose him to develop an HSEA. Secondly, the technique used in this case is unique with respect to the level of laminectomy and manoeuvre employed for pus evacuation. The patient achieved complete neurological and functional recovery despite his pre-operative neurological status (stage 4). The outcome indicates good prognosis of patients with HSEA with neurological deficit when considered for emergent surgical decompression 305 Penetrating spine injury bisecting thoracic spinal canal with no significant neurological deficits—The midline cord syndrome Dr Kaustubh Ahuja1, Dr. Arghya Kundu Chowdhuri1, Dr Bhaskar Sarkar1, Dr Pankaj Kandwal1 1All India Institute Of Medical Sciences, Rishikesh Introduction In India, the incidence of penetrating spine injury (PSI) is increasing because of the increased use of advanced ballistics (missile PSI) among military personnel and sophisticated tools and construction instruments like nail-guns or drills (non-missile PSI) among civilians. These injuries are associated with a risk of neurological damage, central nervous system infections, vascular injury, dural tear followed by CSF leakage, and spinal instability. Case presentation A 35-year-old male presented with a non-missile PSI with retained iron nail bisecting his dorsal spinal cord, without any motor deficits. Patient presented with only left lower limb proprioceptive loss and L1–L3 paresthesia. CT and MRI scan showed the iron nail passing through the T8-T9 vertebral level in sagittal view and passing through the middle of the spinal canal in axial view. Nail removal was done on emergent basis without any further neurological damage. Discussion To the best of our knowledge, this presentation of a non-missile PSI and has not been previously reported. The specific clinical presentation of this distinct type of injury to the midline structures of the spinal cord is hence named “midline cord syndrome”. 449 Bone Loss Following Spinal Cord Injury Dr Moh'd Rami Al-ahmar1, Dr Khalid Al-Qudsi1, Dr Hana Khalidi1 1Jordanian Royal Rehabilitation Spinal Unit, King Hussein Medical Centre Objective: To evaluate the pattern of bone loss and its consequences in a group of spinal cord injured patients managed at the Spinal Unit-Royal Rehabilitation Centre (RRC)-King Hussein Medical Center (KHMC) and its correlation to level, extent of injury, age and time post injury. Methods:This is an extention for a previous study; The Bone Mineral Density (BMD) was measured in a group of patients who sustained Spinal Cord Injury (SCI) (mean duration of SCI 8.6 years) who completed their medical and rehabilitation program at Spinal Unit-(RRC) during the period July, 2003 to Dec, 2018. BMD was measured by dual energy x-ray absorptiometry in the lumbar spine and femoral neck, patients were diagnosed to have osteoporosis according to World Health Organization (WHO) criteria and their fracture’s risk was described from this score using published data. Their spinal injuries were classified according to American Spinal Injury Association Impairment scale (AIS) ranging from A-D. Results: 76 patients were included in the study; there were 62 males and 14 females with male to female ratio (4.4:1). Their age ranged between 13-71 years (mean age 39.5 years). Bone loss indicated by low BMD revealed that femoral region is predominantly affected with relative preservation of the lumbar spine. Abnormal BMD values were detected in 83.6% of subjects. A positive correlation was noticed between the time following the injury and the degree of osteoporosis. Individuals with complete injuries showed lower bone mineral density values compared to those with incomplete lesions. No significant correlation was found regarding their age and gender. Conclusion: Osteoporosis have a huge impact on the individual with SCI. During the acute phase of injury there is need for a prevention strategy to prevent initial, rapid osteoporosis, and to improve rehabilitation outcomes in chronic stages by different means of medical treatment and scientific advances to improve the effectiveness of rehabilitative approaches. 467 Middle East North Africa Spinal Cord Injury Network Dr Moh'd Rami Al-ahmar1, Prof Abderraza Hajjioui2 1Jordanian Royal Rehabilitation Spinal Unit, 2Clinical Neuroscience Laboratory, Faculty of Medicine and Pharmacy, University Sidi Mohammed Ben Abdellah Fez Introduction: For almost 20 years individuals and organisations have been engaged in the establishment, management and implementation of Regional SCI Networks. These Networks have proven to be effective and efficient in promoting cross regional exchange, learning, education, technical capacity development support and research in the field of SCI management. They provide a platform that is enabling health care professionals, SCI consumers, policy makers and managers to come together, share problems , celebrate successes and to find new and innovative approach’s to increasing services and opportunities for people with SCI. Background: In 2001 the Asian Spinal Cord Network was established following a meeting of regional expert in Bangladesh. ASCoN today has 75 member organisations in 18 countries across Asia. Through ASCoNs work • Organisations working in the field of SCI management can address similar problems being faced • There is increased opportunities for ASCoN member organisations to learn from each other • Good examples of SCI management can be replicated across the Region through exchange, training, mentorship. In 2015 the African Spinal Cord Injury Network (AFSCIN) was established. Drawing on lessons from ASCoN , consumers and healthcare workers with an interest in the enhancement of SCI care in Africa came together in Botswana in November 2015 and the Network was officially formed and initiated . Over the past three years I (Dr Rami Al Ahmar), Member of the Education Committee of ISCoS and representative of the MENA region has been discussing with colleagues the possibility of establishing an SCI network in the Region. The following countries have expressed an interest Jordan, Iraq, Egypt, Syria, KSA, Kuwait, UAE,…..in becoming part of this Network and it was established during the last PAN ARAB PM&R congress and the parallel ISCoS workshop which was held in AMMAN October 2017, arrangement and organisations were done to launch officially the network during the very successful 1st MENA SCI meetings and workshops in collaboration with the 8th Annual Rehabilitation and disability conference in Fez , Morocco 7-10th March 2019 Suggested Next Steps: To join small number of SCI units in the MENA region same as the one at King Hussein Medical Centre in order to be the base of MENASCI a small group of then looking for interested Doctors and champions interesting in SCI to join committees for SCI MENA. Future plans; Increase number of the MENA SCI Members and SCI unit (Dr, Nurses, PT, OT, Peer Counsellors, Psychologists, Consumers…etc) Regular annual meeting to exchange experiences Translations for elearning online website Add modules for: Consumers in Arabic Incorporate into undergraduate curriculum & online courses Better coordination of SCI training workshops
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