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PubMed1987

A clinical syndrome of rostral and caudal spinal injury: neurological, neurophysiological and urodynamic evidence for occult sacral lesion.

Patients with spinal cord injury show upper motor neuron dysfunction below the level of the lesion. Some patients with cervical and high thoracic injuries show unexpected lower leg atrophy and ankle jerk abnormalities together with persistence of urinary retention. Clinical, neurophysiological and urodynamic findings in 130 patients with cervical and thoracic injuries showed that 18 patients had additional lumbosacral dysfunction. Three patients had radiological findings demonstrating a second lesion of the lower spine. The remaining 15 patients, however, did not have any obvious bony lesion to account for the lumbosacral dysfunction. Atypical neurological findings, abnormal neurophysiological testing and aberrant detrusor behaviour were the essence of the occult lumbosacral dysfunction in cervical and thoracic spinal cord injury patients. Recognition of the presence of a double lesion was important for care of the neuropathic bladder and pain in addition to understanding the unexpected clinical signs.

Adult↗
PubMed2006

Combined treatment with neurotrophin-3 and LSD facilitates behavioral recovery from double-hemisection spinal injury in neonatal rats.

We explored functional recovery in two spinal cord injury models following a novel combination treatment (NT-3 + LSD). One group of rats received a staggered double hemisection (DH) at postnatal day 2 (P2) of the left hemicord at T11 and the right hemicord at T12. Another group received complete transection (CT) at T11 on P2. A third group was sham operated. Each of these groups was also treated with the drug combination. Drugs were administered intrathecally above the lesion during surgery, and again s.c. at P4, P6, P8, and P10. Intracellular recording in an in vitro spinal cord preparation at P10-P12 in DH rats revealed weak polysynaptic connections to lumbar motoneurons through the injury region, but only in those receiving NT-3 + LSD; NT-3 or LSD alone had no effect. In behavioral experiments, the frequency of rearing in an open field and hindlimb kicks during swimming was assessed every 3-4 days from P9 to P58. Both CT and DH injury severely impaired rearing and hindlimb kicking during swimming. DH rats treated with NT-3 + LSD showed significantly more kicks during swimming than untreated DH or CT rats and treated CT rats beginning as early as P9 and lasting through the duration of testing. Rearing behavior was also improved by treatment but beginning only in the 3rd postnatal week, the time at which it normally develops. Rearing frequency reached sham control levels by P40. Our results suggest this combination treatment may be a promising new strategy for facilitating recovery from moderate spinal cord injury.

Animals↗
PubMed2001

[Functional respiratory evaluation in patients with high traumatic spinal injury].

The restrictive defect was quantified (Forced vital capacity, FVC) and their postural dependence and the respiratory muscle weakness (Maximal inspiratory and expiratory pressures, MIP and MEP) in 29 patients (12 to 46 years) with spinal injury from cervical (C) 4 to thoracic (T) 7 (30 days to 48 months post injury period). The FVC in C (seated) was 2200 +/- 560 ml (47.2%), and in T was 2940 +/- 750 ml (66.6%), p < 0.008. The postural dependence of the FVC was higher in C with an increase of 25% and only of 10% in the T (p < 0.03). This postural dependence was a function of the FVC according to the regression equation: FVC % (supine) = 24.73+ 0.7341* FVC % seated (r 0.8771, p < 0.001). The MIP in C was 61.59 (53.82%) +/- 17.26 cm H2O and in T was 87.25 (77.85%) +/- 24.27 cmH2O (p < 0.05). The MEP in C was 48.53 (24.97%) +/- 18.09 cm H2O, and in T was 58.75 (30.74%) +/- 27.67 cmH2O (p NS). No correlation was found between FVC and maximal statics respiratory pressures. In conclusion, the C showed more significant restrictive defect and a great postural dependence of the FVC. In both, the expiratory muscle weakness was more severe than the inspiratory group. Inspiratory muscle weakness was higher in C.

Adolescent↗
PubMedDate not supplied

Vertebral artery thrombosis after spinal injury: case report.

The vertebral artery and the cervical spine are closely related anatomically, but damage to that vessel in cervical spinal injury and subsequent stroke involving the vertebrobasilar distribution has rarely been reported. A case of vertebrobasilar stroke following traumatic injury to the cervical spine is described. The anatomy of the vertebrobasilar system is reviewed and possible mechanisms of injury discussed. A literature review follows.

Adolescent↗
PubMed2000

Combined treatment with alphaMSH and methylprednisolone fails to improve functional recovery after spinal injury in the rat.

To date, relatively little progress has been made in the treatment of spinal cord injury (SCI)-related neurological impairments. Until now, methylprednisolone (MP) is the only agent with clinically proven beneficial effect on functional outcome after SCI. Although the mechanism of action is not completely clear, experimental data point to protection against membrane peroxidation and edema reduction. The melanocortin melanotropin is known to improve axonal regeneration following sciatic nerve injury, and to stimulate corticospinal outgrowth after partial spinal cord transection. Recently, we showed that intrathecally administered alphaMSH had beneficial effects on functional recovery after experimental SCI. Since both drugs have shown their value in intervention studies after (experimental) spinal cord injury (ESCI), we decided to study the effects of combined treatment. Our results again showed that alphaMSH enhances functional recovery after ESCI in the rat and that MP, although not affecting functional recovery adversely by itself, abolished the effects observed with alphaMSH when combined. Our data, thus, suggest that the mechanism of action of MP interferes with that of alphaMSH.

Action Potentials↗
PubMed1992

Perceptual deprivation in the acute phase of spinal injury rehabilitation.

Patients in intensive care units are often reported to experience psychological disturbances which may be attributable to a number of well-researched causes. However, it is suggested that the total lack of proprioceptive and motor feedback after spinal trauma may be a significant factor in the genesis of these disturbances which are unique to this group of patients. All cases admitted to the Regional Spinal Injuries Centre in Southport from January 1987 through December 1990 were assessed (n = 187) and the conditions surrounding the occurrence of behavioural disturbances (n = 23, 12.3%) established. The level of interaction with relatives and significant others was established for all acute admissions, and low frequency was found to correlate significantly with the development of perceptual deprivation experiences. The effects of inadequate somatosensory input, lesion level, increasing age, and visitor variability for spinal patients is discussed and an algorithm presented to highlight the potential factors associated with aetiology and treatment of the problem. The implications of these findings for the future management of acute spinal trauma are discussed.

Adult↗
PubMed1993

Sonographic diagnosis of heterotopic bone formation in spinal injury patients.

A variety of stimuli including neurological insult may provoke primitive mesenchymal cells to differentiate into bone forming cells. Such a sequel following spinal cord injury can delay rehabilitation, enhance the spasticity and reduce the range of movement in the affected joint. It is characterised by an initial inflammatory phase followed by heterotopic bone formation. The early inflammatory lesion clinically mimics deep vein thrombosis, a developing pressure sore, infection, and tumour. An early diagnosis at a time of clinical uncertainty, before the plain radiographic features develop, has distinct advantages and therapeutic implications. The unique pathological evolution and maturation of the lesion is clearly demonstrated by sequential sonographic (ultrasonic) assessment with depiction of the 'zone phenomena' seen on histology. Sonographic scans in 7 spinal injury patients proved diagnostic, before there was radiographic evidence of bone formation, and confidently excluded HBF in a further 18 patients without any false negative results.

Adult↗
PubMedDate not supplied

Can EMS providers adequately assess trauma patients for cervical spinal injury?

OBJECTIVE: To determine whether EMS providers can accurately apply the clinical criteria for clearing cervical spines in trauma patients. METHODS: EMS providers completed a data form based on their initial assessments of all adult trauma patients for whom the mechanism of injury indicated immobilization. Data collected included the presence or absence of: neck pain/tenderness; altered mental status; history of loss of consciousness; drug/alcohol use; neurologic deficit; and other painful/distracting injury. After transport to the ED, emergency physicians (EPs) completed an identical data form based on their assessments. Immobilization was considered to be indicated if any one of the six criteria was present. The EPs and EMS providers were blinded to each other's assessments. Agreement between the EP and EMS assessments was analyzed using the kappa statistic. RESULTS: Five-hundred seventy-three patients were included in the study. The EP and EMS assessments matched in 78.7% (n = 451) of the cases. There were 44 (7.7%) patients for whom EP assessment indicated immobilization, but the EMS assessment did not. The kappa for the individual components of the assessments ranged from 0.35 to 0.81, with the kappa for the decision to immobilize being 0.48. The EMS providers' assessments were generally more conservative than the EPs'. CONCLUSION: EMS and EP assessments to rule out cervical spinal injury have moderate to substantial agreement. However, the authors recommend that systems allowing EMS providers to decide whether to immobilize patients should follow those patients closely to ensure appropriate care and to provide immediate feedback to the EMS providers.

Adult↗
PubMedDate not supplied

The nursing management of MRSA on a spinal injuries unit.

The aim of this article is to encourage nurses to question their actions when caring for patients with methicillin-resistant Staphylococcus aureus (MRSA). Some of the main effects of isolation are discussed with reference to specific problems encountered by spinal cord-injured patients in isolation. The advantages and potential problems of a policy for the management of MRSA in a spinal injuries unit are outlined. It concludes that it is not always necessary to isolate all patients who are colonized/Infected with MRSA; provided that basic Infection control measures are followed carefully, and staff, patients, and visitors are educated on the risks of MRSA, it is safe to nurse some of these patients on an open ward.

Cross Infection↗
PubMed1981

Spinal injuries.

Explore the source record for details and available documents.

Animals↗
PubMed1984

Underseat pressure distribution in the sitting spinal injury patient.

A device has been developed that can display underseat pressure distributions during sitting. We have found this device to be particularly useful in monitoring the effect of pressure sore surgery on the underseat pressure patterns, in the design of pressure-relieving cushions, and as a device to enable spinal injury staff to locate areas of high pressure at which tissue breakdown (pressure sores) may occur.

Adolescent↗