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PubMed1997

Neuropsychological aspects of the rehabilitation of patients with paralysis from a spinal injury who also have a brain injury.

In order to examine the rehabilitation process of patients suffering from a severe spinal cord injury and who also have a cerebral injury, 322 patients with paralysis from a spinal injury were subjected to neuro-psychiatric and neuro-psychological examinations. On average 20.2% of these patients showed an associated cerebral lesion. The psychological results of such cerebral lesions are summarized under the concept of the co-called organic psychic syndrome (OPS). In 27.7% of these patients no organic psychic syndrome resulted, and in these patients a conventional paralysis rehabilitation could be carried out. 41.6% showed very minor to moderate injuries, with 30.7% being severely disabled from the cerebral injury. Rehabilitation for these patients was modified, using new therapeutic approaches, and also traditional therapeutic methods adapted to the abilities and needs of this patient group. In 25.5% of the patients there was no substantial improvement during the treatment period of initial rehabilitation (x = 12.5 weeks for the treatment of cerebral injury); but in 36.2% of the patients there was substantial improvement and in 38.3% full remission of organic psychic disorders occurred. Improvements in this sphere have a direct bearing on the rehabilitation capacity of this patient group.

Adult↗
PubMed2006

Nonmissile penetrating spinal injury. Case report and review of the literature.

Nonmissile penetrating spinal injuries (NMPSIs) are rare, even among the population of patients treated in large trauma centers. Patients who present with retained foreign body fragments due to stabbings represent an even smaller subset of NMPSI, and their optimal management is unclear. The authors report the case of a 42-year-old man who presented to the University of California at Davis Medical Center with a retained knife blade after suffering a stab wound to the lower thoracic spine. They discuss this case in the context of a literature review and propose management options for patients with NMPSIs in whom fragments are retained. A search of PubMed was undertaken for articles published between 1950 and 2006; the authors found 21 case reports and eight case series in the English-language literature but discovered no published guidelines on the management of cases of NMPSI with retained fragments. After clinicians undertake appropriate initial trauma evaluation and resuscitation, they should obtain plain x-ray films and computerized tomography scans to delineate the anatomical details of the retained foreign body in relation to the stab wound. Neurosurgical consultation should be undertaken in all patients with an NMPSI, whether or not foreign body fragments are present. Surgical removal of a retained foreign body is generally recommended in these patients because the fragments may lead to a worse neurological outcome. Perioperative antibiotic therapy may be beneficial, but the result depends on the nature of the penetrating agent. There is no documentation in the literature to support the use of steroid agents in patients with NMPSIs.

Adult↗
PubMed1992

GM-1 ganglioside in human spinal cord injury.

Spinal cord injury is typically a devastating injury with no or only limited neurologic recovery. Recent papers have reported enhancement of neurologic recovery following spinal cord injury with both methylprednisolone and GM-1 ganglioside. This paper provides additional details of the GM-1 study and a further analysis of recovery of motor function for each of the ten neurologic levels assessed in the study. This additional analysis provides further evidence that the largest enhanced recovery of motor function in the GM-1 treatment group occurred in the muscles of the lower extremities and is consistent with the enhanced recovery occurring in the white matter tracts passing through the level of injury.

Adult↗
PubMedDate not supplied

[Magnetic resonance imaging in the diagnosis of spinal injuries].

Magnetic resonance imaging reveals the morphological changes of the spinal cord in the early and late periods following vertebral and spinal cord injuries. Edema frequently accompanied by squeezing and displacement of the spinal cord by the elements of broken vertebrae and disks, which are dislocated into the lumen of the spinal canal is the most common change in the early period. In the late period, there is myelomalacia that progresses to cerebrospinal cyst. End-stage injury is characterized by spinal atrophy, intra- and extramedullar cerebrospinal cysts and cicatricial and adhesive changes in the spinal canal.

Adolescent↗
PubMed1992

GM-1 ganglioside in human spinal cord injury.

Spinal cord injury is typically a devastating injury with no or only limited neurologic recovery. Recent papers have reported enhancement of neurologic recovery following spinal cord injury with both methylprednisolone and GM-1 ganglioside. This paper provides additional details of the GM-1 study and a further analysis of recovery of motor function for each of the ten neurologic levels assessed in the study. This additional analysis provides further evidence that the largest enhanced recovery of motor function in the GM-1 treatment group occurred in the muscles of the lower extremities and is consistent with the enhanced recovery occurring in the white matter tracts passing through the level of injury.

Adult↗
PubMed1986

The treatment of soft tissue after spinal injury.

There are a number of modalities available for the treatment of soft tissue that are applicable to spinal injuries. Each has a long history of use; however, there is relatively little scientific data to support the effects often seen in the clinical setting. Only through careful evaluation and specific diagnosis can these methods of treatment be utilized to their fullest potential. The underlying pathology must always be addressed as well as its soft-tissue manifestations. Direct treatment of the mechanical derangement must take precedence when such conditions exist. The total treatment must incorporate patient education in posture and positioning as well as prophylactic measures. In later stages of rehabilitation, a general strengthening program to further prevent reinjury should be embarked upon. It must always be remembered that treatment of soft tissue alone rarely provides long-lasting relief of symptoms.

Athletic Injuries↗
PubMed1987

[Indications for surgical treatment of spinal injuries].

Now as before, a deteriorating paraplegia as well as a partial transverse lesion are absolute indications for a stabilization of spinal injuries. The operation has to be carried out within a few hours after the accident. A complete transverse lesion as well as an instable situation in the spine are relative indications for surgery. In these cases, the operation should be performed as early as possible considering the easier reposition and the possibility of an earlier beginning of rehabilitation measures. The condition of the posterior vertebral body edge, the root of the vertebral arch and the articular process of a vertebra are decisive for the stability of the spine. Acute surgery in injuries to the spine is dependent on the operability of the patient, the presence of a surgeon skilled in spinal surgery together with an appropriate staff, and the possibility to produce at any time a CT scan of the spine.

Fracture Fixation, Internal↗
PubMed1988

Sexuality and spinal cord injury.

Spinal cord injury may have a profound effect on the patient's sexuality. In order to maximize the patient's potential, concern and support from health care professionals is needed. This article reviews normal sexual function and changes occurring following spinal cord injury. The PLISSIT model is described and is used to describe nursing interventions designed to deal with the sexual concerns of spinal cord-injured patients.

Humans↗
PubMed1995

[Reconstructive operations on soft tissues in the treatment of bedsores in patients with spinal injuries].

The paper presents the results of plastic operations on 54 trochanterian bedsores in 48 patients with complicated spinal injury. Early positive results were obtained in 100% of cases when various modifications of a skin-subcutaneous flap was applied in 16 patients with 17 bedsores. There were relapses in 4 patients following a year. A full-layer skin-subcutaneous-fasciomuscular flap was employed in 33 patients with 37 bedsores. A poor result, namely flap non-acceptance, was seen in one case. Late relapses were absent. It is most expedient to use full-layer flaps in the treatment of bedsores in the tronchaterian area in terms of its anatomic features.

Follow-Up Studies↗
PubMed2005

Motor vehicle mismatch-related spinal injury.

BACKGROUND/OBJECTIVE: Motor vehicle collision (MVC)-related spinal cord injury (SCI) is the most prevalent etiology of SCI. Few studies have defined SCI risk factors. Vehicle mismatch occurs in 2-vehicle MVCs in which there are significant differences in vehicle weight, stiffness, and height. This study examined SCI risk and vehicle mismatch. METHODS: A matched case-control study using the 1995 to 2003 National Automotive Sampling System (NASS). Study subjects were identified from 2-vehicle MVCs. Cases were occupants who had suffered a cervical, thoracic, or lumbar SCI. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS: There were 101,682 cases of SCI matched to 805,091 controls. Occupants of passenger vehicles involved in MVCs with a light truck or van (LTV) were at increased risk for SCI (OR = 1.87, 95% CI = 1.07-3.24) and this risk was greatest for thoracic SCI (OR = 5.09, 95% CI = 2.33-11.13). In addition, occupants of LTVs involved in MVCs with passenger vehicles were at significant increased risk for cervical (OR = 1.39) and lumbar (OR = 2.65) SCI; and occupants of LTVs involved in MVCs with other LTVs were at increased risk of any SCI (OR = 2.02, 95% CI = 1.52-2.69). For these subjects, significant increased risks were seen for all spine regions: cervical (OR = 1.41), thoracic (OR = 2.86), and lumbar (OR = 2.38). CONCLUSIONS: The results of this study suggest that occupants of passenger vehicles are at increased SCI risk when involved in 2-vehicle MVCs with LTVs; and that occupants of LTVs are at increased SCI risk, regardless.

Adult↗
PubMed2003

Cervical transforaminal injection of corticosteroids into a radicular artery: a possible mechanism for spinal cord injury.

Spinal cord injury has been recognized as a complication of cervical transforaminal injections, but the mechanism of injury is uncertain. In the course of a transforaminal injection, an observation was made after the initial injection of contrast medium. The contrast medium filled a radicular artery that passed to the spinal cord. The procedure was summarily abandoned, and the patient suffered no ill effects. This case demonstrates that despite using careful and accurate technique, it is possible for material to be injected into a radicular artery. Consequently, inadvertent injection of corticosteroids into a radicular artery may be the mechanism for spinal cord injury following transforaminal injections. This observation warns operators to always perform a test injection of contrast medium, and carefully check for arterial filling using real-time fluoroscopy with digital subtraction.

Adrenal Cortex Hormones↗
PubMed2002

Role of group II and group III metabotropic glutamate receptors in spinal cord injury.

Spinal cord injury (SCI) produces an increase in extracellular excitatory amino acid (EAA) concentrations that results in glutamate receptor-mediated excitotoxic events. An important class of these receptors is the metabotropic glutamate receptors (mGluRs). mGluRs can activate a number of intracellular pathways that increase neuronal excitability and modulate neurotransmission. Group I mGluRs are known to modulate EAA release and the development of chronic central pain (CCP) following SCI; however, the role of group II and III mGluRs remains unclear. To begin evaluating group II and III mGluRs in SCI, we administered the specific agonists for group II, APDC, or group III, L-AP4, by interspinal injection immediately following SCI. Contusion injury was produced at spinal segment T10 with a New York University impactor (12.5-mm drop, 10-g rod 2 mm in diameter) in 30 adult male Sprague-Dawley rats (175-200 g). Evoked and spontaneous behavioral measures of CCP, locomotor recovery, changes in mGluR expression, and amount of spared tissue were examined. Neither APDC nor L-AP4 affected locomotor recovery or the development of thermal hyperalgesia; however, L-AP4 and APDC attenuated changes in mechanical thresholds and changes in exploratory behavior indicative of CCP. APDC- and L-AP4-treated groups had higher expression levels of mGluR2/3 at the epicenter of injury on post contusion day 28; however, there was no difference in the amount of spared tissue between treatment groups. These results demonstrate that treatment with agonists to group II and III mGluRs following SCI affects mechanical responses, exploratory behavior, and mGluR2/3 expression without affecting the amount of tissue spared, suggesting that the level of mGluR expression after SCI may modulate nociceptive responses.

Aminobutyrates↗
PubMed1995

[Use of local hypothermia in complicated spinal injuries (clinical and experimental studies)].

Experimental data on 116 adult mongrel dogs and clinical findings of 121 patients with complicated spinal injury who had been operated on at Moscow Clinical Hospital No. 67 which is a basis of the Clinic of Traumatology, Orthopedics and Military Surgery, I.M. Sechenov Moscow Medical Academy, underlay the authors' research material. Experimental studies of the impact of local cooling of the intact spinal marrow indicated that there were the least changes in the temperature range of +9 to +11 degrees C with a session lasting 2-3 hours. Experimental histological studies of nerve tissue with hemisection demonstrated that two-hour local hypothermal sessions at 2- or 3-hour intervals proved to be optimal within the first 2 postoperative days. Clinically, the intraoperative regional spinal cooling at the last stage showed a 1.5-2-fold reduction in blood loss and exerted a profound hemostatic effect. Its postoperative local cooling produced analgetic and spasmolytic effects and improved cerebral blood flow. The application of local spinal hypothermia by the procedure developed by the authors is within reach at any medical institution.

Animals↗
PubMed1977

Topical or no anaesthesia for external urethral sphincterotomy in neurogenic vesical dysfunction due to spinal injury.

Considerable controversy exists regarding the ideal anaesthetic coverage for external urethral sphincterotomy in spinal injury patients with detrusor-sphincter dyssynergia. From this preliminary experience on 34 patients in whom this procedure was indicated and then attempted under topical (urethral instillation of 20 ml of 2 per cent Lignocaine jelly) or no anaesthesia, we are encouraged into believing that these patients may not require general or regional anaesthesia for this operation.

Aged↗
PubMed1986

Experience with spinal injuries in New South Wales.

Two hundred and two patients with acute and severe spinal injuries were treated in various hospitals in New South Wales during 1977 and 1978. Of these, 132 (65%) were cervical, 60 (30%) thoracic, eight (4%) lumbar and two were inadequately recorded. A major concurrent injury to the head was present in every third patient, to the chest in every fourth patient, and to the limbs in every fifth patient. The outcomes of patients reported in this series make it one of the worst in the literature. Sixty-nine (34%) patients died in hospital; of the 133 survivors, only 22 (11%) have resumed work, the remainder being partially or totally disabled. It is estimated that another 302 patients died before arrival in hospital. In country areas, the time lags between accident and ambulance notification, and between notification and arrival at hospital, were uncertain in many cases, but periods in excess of 2 hours were recorded in 28 (14%). One-man ambulances or private vehicles were used in at least 43 cases (21%). After admission, 139 patients were transferred to other hospitals for definitive treatment, arriving after an average time of 22 h (median time 9 h); for such patients, the original hospital presumably served as a first aid station. A case control study suggests that preventable delay in transport, inappropriate treatment, and failure to correct shock may have been causative factors in 16 deaths in this series. Reduction of the time lag between accident and institution of definitive treatment will save lives, and may avoid some crippling neurological deficits.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents↗