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Magnetic resonance imaging of spinal injury.

Magnetic resonance imaging (MRI) was performed on 30 patients following spinal injury (SI). Spin-echo sequences and surface coils were used for all patients. Plain radiographs, high-resolution computed tomography (CT), and MRI were compared for the delineation of bone, disc, and ligament injury, measurement of sagittal spinal canal diameter and subluxation, epidural hematoma, and spinal cord structure. Myelography or intrathecal contrast-enhanced CT were not performed on any of these patients. Magnetic resonance imaging accurately delineated intraspinal pathology in two of four patients with acute penetrating SI, and was normal in the other two patients. In 16 patients with acute nonpenetrating SI, MRI was superior to CT for visualizing injuries to discs, ligaments, and the spinal cord, while CT was superior to MRI in characterizing bony injury. Computed tomography and MRI provided similar measurements of subluxation in six of six patients and of sagittal spinal canal diameter in three of four patients. In ten patients with chronic SI, MRI demonstrated post-traumatic cysts, myelomalacia, spinal cord edema, and the presence or absence of spinal cord compression. In patients with acute penetrating SI and chronic SI, MRI provided comprehensive clinical information. In patients with acute nonpenetrating SI, the information obtained by MRI complemented the data given by plain radiographs and CT, allowing clinical decisions to be made without the need of invasive imaging modalities.

Adolescent↗

Pressor response during cystomanometry in spinal injury patients complicated with detrusor-sphincter dyssynergia.

Herein attention is focused on the documentation of high blood pressure response with detrusor-sphincter dyssynergia in spinal cord injury patients and with its amelioration after extended sphincterotomy. During cystomanometric evaluation of the bladder the monitored blood pressure response in 53 spinal injury patients, 27 non-dyssynergic spinal injury patients and 18 non-spinal injury patients was compared. A high correlation was observed among the magnitudes of blood pressure increase, level of injury and the severity of detrusor-sphincter dyssynergia in spinal injury patients. During cystomanometry blood pressure increases of greater than 20 mm. Hg systolic and 10 mm. Hg diastolic in normotensive paraplegics (below T5) and also in non-spinal injury patients were significant to suspect detrusor-sphincter dyssynergia. In normotensive tetraplegic patients blood pressure increases of greater than 40 mm. Hg systolic and 20 mm. Hg diastolic were significant to suspect detrusor-sphincter dyssynergia. The mechanism of blood pressure increase is elucidated. The management of this high blood pressure response in patients with detrusor-sphincter dyssynergia by drug therapy and extended sphincterotomy is discussed. Based on our experience the use of carbon dioxide for cystomanometry seems preferable in patients with spinal lesions above T5 since expedient deflation of the bladder can prevent an inordinate blood pressure increase.

Adrenergic alpha-Antagonists↗

A survey of spinal injuries from diving. A study of patients in Pretoria and Cape town.

A highly significant feature emerged from a study of patients with spinal injuries from diving treated at the H.F. Verwoerd Hospital and the Conradie Hospital, namely an area specificity with regard to cause of injury, circumstances and social habits. The typical patient presenting with spinal injuries from diving is a young male, the injury often being the result of the facing of a 'challenge' at a social gathering where alcohol consumption played an important role. The injurious dive is usually not a first attempt and is often into a pool of some sort or at a location well known to the patient. The forehead or vertex may strike either the bottom of the pool, a rock, or a sandbank, without any additional injuries, e.g. to the hands. The radiographs reveal a flexion-axial compression injury to the C4-C6 region of the spine, leaving the majority of such patients in a state of permanent and complete tetraplegia. Although many of these catastrophes are truly accidental, a large number of patients admit to a careless attitude which was the direct cause of their misfortune.

Adolescent↗

[Acute stage of spinal injury (physiopathology). "Ischemic damage to the spinal cord"].

Several pathophysiological events follow spinal cord trauma. Vascular abnormality and changes in spinal cord blood perfusion occur immediately after injury primarily within the gray matter. Progressive biochemical and histological alterations take place both in gray and white matter subsequently. The significant metabolic and ionic alterations, all of which are interdependent (reduction in energy substrate, enzymes and neurotransmitters release alterations, ionic fluxes changes) result either in loss of functional activity or structural integrity in the injured spinal cord and remains a matter of speculation.

Humans↗

Spinal injuries in contact sports.

Contact and collision sports such as American football expose the athlete to a wide array of potential injuries. Knee injuries garner much of the attention, but spinal injuries are potentially catastrophic and all levels of medical coverage of football must be knowledgeable and prepared to attend to an athlete with a neck injury. Of the other possible spinal conditions, some resolve on their own, others might require conservative therapy, and still others might require surgical intervention. The spectrum of potential injury is wide, yet the medical team must practice and prepare to treat the possible catastrophic neck injury.

Athletic Injuries↗

Review of the social situation of paraplegic and tetraplegic patients rehabilitated in the Hexham Regional Spinal Injury Unit in the north of England over the past four years.

The various aspects of the social circumstances of patients rehabilitated in the North of England Regional Spinal Injury Unit between 1975 and 1979 have been investigated. The study was carried out by making use of computerised analysis of a specially developed questionnaire. A Research Medical Social Worker was appointed to visit each patient at their home in order to record all relevant information into the questionnaire. A summary of the resulting information is presented. The study has been of particular value in two respects. Firstly, it has revealed the comprehensive social circumstances of these patients. Secondly, it has enabled us to evaluate the quality of service provided by the Hexham Regional Spinal Injury Unit, and it has enabled us to recommend an expansion of some of the aspects of the service provided by a Spinal Injury Unit.

Adolescent↗

Hemodynamic alterations in the paravertebral venous plexus after spinal injury.

PURPOSE: To assess the prevalence of altered venous hemodynamics after spinal cord injury. MATERIALS AND METHODS: The authors performed venography in 200 ambulant patients and 107 patients with spinal injury. The hemodynamic characteristics of the paravertebral venous plexus were documented after pedal injection of contrast material. The hemodynamic and clinical data were correlated in patients with spinal cord injury. RESULTS: Abnormal venous return via the paravertebral venous plexus in the absence of iliac or inferior vena caval occlusion was shown in 73 (68%) of the 107 patients with spinal injury. This paravertebral venous flow route is not related to the time between injury and examination. It was demonstrable in the early as well as late post-traumatic period and was reproducible at subsequent examinations. The paravertebral venous flow route was more commonly seen in cervical than thoracolumbar injuries and was closely related to the severity of neurologic deficit (P = .0012). CONCLUSION: Abnormal vertebral venous hemodynamics occur in most patients with spinal cord injury and are more likely to occur in patients with complete neurologic deficit and cervical injury.

Case-Control Studies↗

Cervical spinal injuries caused by collision of cars with camels.

We report 16 patients who sustained spinal injuries by collision of their cars with camels. Out of the 16 patients, 10 had severe spinal injuries with neurological deficits. The pattern of injury, possible mechanism of injury and recommendations for avoiding these severe injuries are suggested.

Accidents, Traffic↗

Social adjustment and rehabilitation in international competitors with spinal injuries sustained in military service.

One hundred and eighteen competitors, with spinal injuries, attending the First International Ex-Service Wheelchair Games, held in July 1993, were interviewed. Athletes from 17 countries attended. Sixteen competitors were tetraplegic and 102 paraplegic, their injuries are detailed below. The injuries had occurred on average 14.0 years previously: 35 injuries were war injuries a further 10 due to combat training. The paraplegic athletes had spent 9.6 months and the tetraplegic 12.3 months in hospital. Fifty-five spinal stabilizations had been performed, and this was associated with a reduced inpatient stay for the paraplegic athletes (7.7 months vs 11.3 months). Spinal fixation did not affect later employment. Thirty-one athletes worked, and the amount of pension had no significant bearing on the numbers working. There was a mean delay of 38.3 months from injury until return to sport, and only 11.8% of competitors took up sport in the initial rehabilitation period. The differences between operative treatment, inpatient stay and numbers working from the different countries are compared. Financing of attendance and training seemed to be informal, with just over half of the athletes financed by their governments. The role of sport in rehabilitation of those patients with spinal injuries, and specifically those injured whilst serving in the armed forces, is discussed.

Adult↗

Opioid peptide messenger RNA expression is increased at spinal and supraspinal levels following excitotoxic spinal cord injury.

Spinal cord injury in rats is known to cause anatomical, physiological and molecular changes within the spinal cord. These changes may account for behavioral syndromes that appear following spinal cord injury, syndromes believed to be related to the clinical condition of chronic pain. Intraspinal injection of quisqualic acid produces an excitotoxic injury with pathological characteristics similar to those associated with ischemic and traumatic spinal cord injury. In addition, recent studies have demonstrated changes in blood flow, neuronal excitability and gene expression in the brain following excitotoxic injury, indicating that behavioral changes may result from modification of neuronal substrates at supraspinal levels of the neuraxis. Because changes in spinal opioid peptide expression have been demonstrated in models of traumatic spinal cord injury and chronic pain, the present study investigated messenger RNA expression of the opioid peptides, preproenkephalin and preprodynorphin, at spinal and supraspinal levels following excitotoxic spinal cord injury. Male, Long-Evans rats were given three intraspinal injections of quisqualic acid (total 1.2 microl, 125mM). After one, three, five, seven or 10days, animals were killed and quantitative in situ hybridization performed on regions of the spinal cord surrounding the lesion site, as well as whole-brain sections through various levels of the thalamus. Preproenkephalin and preprodynorphin expression was increased in spinal cord areas adjacent to the site of quisqualic injection and in cortical regions associated with nociceptive function, preproenkephalin in the cingulate cortex and preprodynorphin in the parietal cortex, both ipsilaterally and contralaterally at various time-points following injury. These results further our knowledge of the secondary events that occur following spinal cord injury, specifically implicating supraspinal opioid systems in the CNS response to spinal cord injury.

Animals↗

The management of spinal injuries--past and present.

This review paper surveys historical aspects and then proceeds to examine major considerations in the management of spinal injuries. These include neurological sequelae, functional disabilities and expectations, pathology, spinal cord injury in children, management complications (genitourinary, bone, neurological, skin respiratory, cardiovascular, and gastrointestinal), and social aspects. The paper concludes by highlighting the need for comprehensive spinal injury services, noting the bleak future for a reduction in incidence, and emphasizing the goal of care in the community at large, not just in hospital.

Bacteriuria↗

Fractures of the sternum associated with spinal injury.

Twelve cases of sternal injury associated with spinal fractures have been reviewed. The sternum is regularly buckled or fractured in patients with high thoracic spinal fractures. Our review suggests that sternal injuries may also be associated with spinal fractures outside this region, and with types of fracture other than crushing of vertebral bodies. Injury to the sternum, when due to indirect violence, is almost always associated with a severe spinal column injury. A displaced fracture of the thoracic spine, with or without an associated sternal fracture, can produce significant widening of the mediastinal shadow on a chest radiograph. This is caused by a paravertebral haematoma, and can be difficult to differentiate from widening due to an aortic rupture.

Aortic Rupture↗

[Pulmonary embolism as one cause of death after spinal injury--the role of clexane].

The paper deals with fatal pulmonary embolism in patients treated at STOCER after spinal injuries, frequently with neurological impairment. A group of 417 patients treated between 1988 and 1989 has been compared with another one of 350 patients treated between 1995 and 1996. Antyembolic prophylactics has been employed in both groups: an Aspirin in the first group and Clexane in the second one. Forty-seven fatalities (11% of all patients) occurred in the first group (2 females, 44 males, mean age 55.1 years); 40% of them caused by pulmonary embolism (5% of all patients). Twenty-nine fatalities (8% of all patients) occurred in the second group (1 female, 28 males, mean age 60.2 years) 17% of them caused by pulmonary embolism (1.4% of all patients). A comparison between these groups indicates high efficacy of clexane antyembolic prophylactics in patients treated due to spinal injury especially if complicated neurologically.

Anticoagulants↗

Comparison of the revised 2000 American Spinal Injury Association classification standards with the 1996 guidelines.

OBJECTIVE: This study was undertaken to determine the level of agreement between the most recent change in the American Spinal Injury Association International Standards (2000) and the previous (1996) classification. DESIGN: In a spinal cord injury rehabilitation hospital, data were collected on 94 subjects who had an initial neurologic examination according to the International Standards within 1 wk of injury and again at 1 yr. Comparisons were examined of the level of agreement between the 1996 and 2000 revisions in classification of the motor incomplete levels and ability to prognosticate outcome at 1 yr on the basis of the initial examination. RESULTS: Near perfect agreement between the 1996 and 2000 revised guidelines in the classification of motor incomplete injuries was found, with no statistically significant difference for prognosticating neurologic recovery at 1 yr on the basis of the initial examination. CONCLUSION: The 2000 revisions do not offer a significant difference in American Spinal Injury Association impairment classification or in predicting neurologic recovery at 1 yr.

Female↗

Environmental control systems in a spinal injuries unit: a review of 10 years' experience.

In 1979 a 30-bed spinal injuries unit was opened at Burwood Hospital in Christchurch, New Zealand. The design of the building included built-in environmental control facilities for tetraplegic patients. This paper outlines 10 years of experience with environmental controls in a hospital setting, and discusses some of the problems encountered. Special mention is made of ease of setting up equipment, patient interface switches, patient acceptance, and a major upgrade and modification of the original control system. Although not utilized as much as originally anticipated, a definite need for environmental controls with the spinal injuries unit has become firmly established.

Activities of Daily Living↗

[Morphological changes in lungs of patients with spinal injuries died in hospital].

Morphological characteristics of changes in the spine and lungs in patients with spinal injuries dead in hospital are described. Spinal edemas were detected in all cases. Edemas were found even in subjects dead at the place where the injury was inflicted. Morphological changes in the lungs were characterized by a phase-wise process, depended on the volume of injury, duration of hospitalization, medical care rendered, and manifested by disorders of blood content of the organ, development of tissue edema, and pneumonia. These data do not rule out the development of pneumonia in patients with spinal injuries.

Adult↗

The effect of an alpha-2 agonist on bladder function and cord histology after spinal cord injury.

Spinal injury in cats is accompanied by urinary bladder and hind limb dysfunction. Ten cats subjected to spinal contusion at the ninth thoracic segment were treated with guanabenz (an alpha-2 agonist) intraperitoneally (0.65 mg./kg.) three hours after injury, and twice daily for eight weeks. An additional six spinal cats were untreated and served as controls. Urodynamic studies were performed on a weekly basis on all animals. Guanabenz modified the vesico-somatic reflex: detrusor-sphincter dyssynergia was either ablated or abolished. In contrast, the controls demonstrated detrusor-sphincter dyssynergia, high residual urine, and spasticity below the lesion. Histological evaluations of the spinal cords revealed that the six paraplegic animals (untreated) suffered marked cavitation of the cord and complete destruction of the grey matter. The five incomplete paraplegic animals (treated) showed minimal cavitation with some preservation of the grey matter. The five ambulators (treated) demonstrated some distortion of grey matter with preservation of white matter. Treatment with guanabenz post traumatic cord injury results in decreased cord cavitation. Detrusor-sphincter dyssynergia is diminished and hind limb function is improved in treated animals.

Adrenergic alpha-Agonists↗