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PubMed2004

Atypical spinal cord injury: spinal dural arteriovenous fistula.

Spinal dural arteriovenous fistulas (SDAVF) are vascular anomalies composed of intertwining arteries and veins with direct arteriovenous (AV) communication. It is presumed that the fistula is an acquired abnormality that produces an arterialization and increase in venous blood flow leading to venous hypertension, venous congestion with eventual hypo-perfusion, or ischemia of the spinal cord. Symptoms include progressive sensory and motor changes that commonly take place over a 2- to 3-year time span. Exacerbation of symptoms is frequently the reason for additional diagnostic work-up. Treatment is aimed at elimination of the communication between arteries and veins. Treatment options include surgical resection of the piece of dura containing the AV fistula, transvascular embolization, or a combined procedure. Outcome is a function of the extent of cord injury and full recovery is rare. Rehabilitation is crucial in maximizing functional outcomes. It is essential for the nurse caring for the patient with a SDAVF to understand the pathological changes related to the fistula, correlate clinical findings, identify diagnostic tools for evaluation, and differentiate treatment options. An understanding of the disorder will provide the groundwork for the nurse to formulate a plan of care identifying patient needs from assessment parameters, rehabilitation needs, and patient education.

Aged↗
PubMed2002

Traumatic injuries: imaging of spinal injuries.

Severe (high-energy) spinal injuries are common sequelae of acute traumas. The task of radiology is to establish the radiological diagnosis, classify it, judge stability and instability and lead further radiological evaluation in cases of non-agreement between the radiological diagnosis and the clinical (neurological) findings. While skeletal abnormalities are best diagnosed with spiral CT and to a lesser degree with plain-film radiographs, soft tissue lesions, such as cord injuries or ligament ruptures, are best outlined with emergency MRI. The classification of fractures depends on fracture (trauma)-biomechanics and location. All these efforts are necessary to get the best clinical outcome for the patient.

Humans↗
PubMed2005

Neglected spinal injuries.

Neglected spinal injuries secondary to overlooked diagnosis may result in serious medical and medicolegal problems. These are not uncommon but are reported infrequently in the medical literature. I studied the incidence, causes, and consequences of neglected spinal injuries and recommendations for prevention and treatment by reviewing the literature found in a Medline search. Overlooked spinal injuries are most frequently seen in unconscious or intoxicated patients and in polytrauma patients with distracting remote injuries. These are 4.5 times more frequent in the cervical spine compared with the thoracolumbar spine. The most common cause is failure to obtain radiographs. Other causes include a failure to recognize the injury or the fact that the initial studies may fail to show the injuries. Use of computed tomography and magnetic resonance imaging scans as screening tests may be good ways to diagnose these injuries, but their use is limited by cost and availability. The most serious consequence of overlooked spinal injuries is progressive neural deficit. More frequently they result in progressive deformity and persistent pain requiring surgical intervention that most likely could have been avoidable, often with an unsatisfactory outcome. Untreated or inadequately treated spinal injuries with late presentation are more often seen in the developing world. Unfortunately, reports on these cases are published rarely. Their brief report in the current study is based on search of nonindexed medical journals using in Internet search engine and personal communications.

Cervical Vertebrae↗
PubMed1991

The interobserver reliability of the revised American Spinal Injury Association standards for neurological classification of spinal injury patients.

To test the interobserver reliability of clinicians using the American Spinal Injury Association's 1989 revised "Standards for Neurological Classification of Spinal Injury Patients," two quizzes were given to 15 house officers and physician faculty members of a department of Physical Medicine and Rehabilitation. The first quiz consisted of five spinal cord injury cases of varying degrees of complexity. The participants were asked to classify each case with respect to sensory level, motor level, zone of injury and Frankel classification by using the original standards. Two months later, after a brief explanation of the significant changes in the revised standards, the same group was given five slightly different cases to classify. With the use of the 1989 revision of the standards, the percent correct improved for Frankel grade (65-81%), motor level (59-85%), sensory level (71-93%) and zone of injury (31-89%). Many of the same type of errors were repeated in both quizzes, i.e., T-12 and L-1 sensory level distinction and the classification of thoracic motor levels. We conclude that the interobserver reliability for the revised ASIA standards, although improved, continues to be less than optimal. We recommend that changes clarifying sensory levels near the inguinal ligament and motor level classification with very incomplete injuries be made in the standards. In addition, training methods should be developed to improve the interobserver reliability of the standards when they are used by clinicians and researchers.

Humans↗
PubMed1984

Early management of spinal injuries.

Traumatic spinal injuries are a major health problem. Any accident victim suspected of having a spinal injury must be immobilized immediately to prevent further damage to the spine. Management is directed toward achieving the most favorable environment for spinal cord recovery. This includes maintaining adequate oxygenation and blood flow and restoring the integrity of the spinal canal as rapidly as possible.

First Aid↗
PubMed1980

Associated injuries in patients with spinal injury.

The associated injuries found in 100 consecutive spinal injuries are described. Fifty-one of the patients had injuries of the cervical cord, 31 per cent complete. A total of 75 per cent of the patients had associated injuries, the commonest being a head injury. Chest injuries were the next most frequent. The management of these injuries in the presence of a severe spinal injury is described. The importance of early tracheostomy and prophylactic anticoagulant therapy is stressed in reducing the mortality to the order of 2 per cent. The value of spinal injury units is emphasized.

Abdominal Injuries↗
PubMed1981

Dopamine partially mediates the cardiovascular effects of naloxone after spinal injury.

Following spinal injury, the opiate antagonist naloxone selectively elevates plasma dopamine levels, with the dopamine changes significantly correlated with improved cardiovascular function. Moreover, the cardiovascular effects of naloxone are significantly attenuated by pretreatment with the dopamine antagonist domperidone. From these data, it is concluded that the cardiovascular effects of naloxone after spinal injury are in part dopamine mediated.

Animals↗
PubMed1994

[Follow-up of spinal injuries with transverse spinal cord lesion].

There are several scores available for assessment of disability and handicap in rehabilitation. In primary treatment most interest has so far been given to the assessment of neurological recovery after operative decompression of the spinal cord. Comparison of the results obtained with this method and the outcome in patient groups treated conservatively revealed no quantitative differences. However, the quality of results was found to be better after surgery, particularly in the functional outcome. Scores should take account of this. The neurological classification of ASIA, IMSOP and DMGP seems to be suitable for assessment of the course through-out the rehabilitation period.

Activities of Daily Living↗
PubMed2002

Prophylaxis of thromboembolism in spinal injuries--survey of practice in spinal units in the British Isles.

AIM: Survey and discussion of the current thromboembolic prophylaxis practice in spinal injury units within the British Isles. BACKGROUND: Deep vein thrombosis and pulmonary embolism are major causes of morbidity and mortality in patients with spinal injuries. A wide range of thromboprophylactic measures have been proposed. The optimum treatment and duration for thromboprophylaxis in spinal injuries is unknown. Different spinal units within the British Isles use different measures despite similar training backgrounds. The present study was performed to review practice and make suggestions on best practice using literature review. METHODS: All the 13 regional and national spinal injury referral centres within the British Isles were contacted to find out their protocols for thromboembolic prophylaxis in patients with acute spinal injuries. RESULTS: All units replied. A wide variation in methods used was found in different spinal units ranging from no chemical prophylaxis to oral anticoagulation with warfarin and contrasting views on the use of antithromboembolic stockings. CONCLUSION: All units recognised the risk of thromboembolism after spinal injuries. A wide variety of thromboprophylactic measures are used.

Anticoagulants↗
PubMed2001

Distracting painful injuries associated with cervical spinal injuries in blunt trauma.

UNLABELLED: Distracting painful injuries (DPIs) may mask symptoms of spinal injury in blunt trauma victims and form an important element in a decision instrument used to identify individuals who require cervical spine radiography. OBJECTIVE: To identify the types and frequencies of injuries that actually act as DPIs among blunt trauma patients undergoing cervical spinal radiography. METHODS: This was a prospective observational study of consecutive blunt trauma victims presenting to an urban Level 1 regional trauma center between April 1, 1998, and September 30, 1998. Prior to cervical spinal radiography, treating physicians evaluated each patient to determine whether a DPI was present or absent and, if present, what type of injury was sustained. Injuries were categorized as fractures, soft-tissue injuries and lacerations, burns, visceral injuries, crush injuries, or other injuries. RESULTS: Data were collected for 778 patients, between 1 month and 98 years old, of whom 264 (34%) were considered to have DPIs. Physicians were unable to determine the DPI status in 47 (6%) additional cases. Fractures accounted for a majority of DPIs (154, or 58%), 42 (16%) were soft-tissue injuries or lacerations, and 86 (34%) were due to a variety of other entities, including visceral, crush, burn, or other miscellaneous injuries. Among the 37 (5%) patients with an acute cervical spinal injury, 20 (54%) had a DPI, including three (8%) who had DPI as the only indication for cervical radiography. CONCLUSIONS: A significant number of blunt trauma patients are believed by clinicians to have DPIs that can possibly mask the presence of cervical spinal injury. Fractures and trauma to soft tissues are the most common types of DPI.

Adult↗
PubMed1992

Pediatric spinal injury: review of 174 hospital admissions.

Injury to the spinal column and spinal cord occurs relatively infrequently in the pediatric population. A review of 174 pediatric patients is presented, representing 5.4% of all patients admitted with spinal injury. Spinal cord injury was present in 45% of patients. A distinct injury profile, explained by anatomical and biomechanical features, distinguishes the young patient with an immature spine from older adolescents with a more mature, adult-like spine. The younger patients, while less likely to have spinal injury, had a higher incidence of neurological injury, in addition to a higher frequency of both spinal cord injury without radiological abnormality and upper cervical cord injury. In addition, younger patients with spinal cord injury and no radiological abnormality were more likely to have complete or severe cord injury. Prognosis was determined by the severity of spinal cord injury. Patients with complete cord injuries showed little improvement, while patients with incomplete injuries generally fared much better, with 74% showing significant improvement and 59% experiencing a complete recovery of neurological functions. There were six deaths, but none was attributed solely to spinal injury. The authors conclude that outcome is quite good after pediatric spinal cord injury that does not produce a physiologically complete cord deficit.

Adolescent↗