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PubMed1977

Paraplegia from traumatic spinal injury.

Acute spinal injury with paresis or paralysis is an increasing problem in modern communities. The corrdinated efforts of many are necessary for its management. The expertise developed by various disciplines through work with nonparaplegic patients should be coupled with the specific expertise of those responsible for total care. Generally, operative techniques have only a limited application, whereas basic medical and nursing techniques give good results.

Contracture↗
PubMed2003

Classification of spinal injuries based on the essential traumatic spinal mechanisms.

STUDY DESIGN: A biomechanical unitary classification of spinal injuries is proposed. OBJECTIVE: To present an evaluation of spinal injuries based on the essential traumatic spinal mechanisms: axial deformation, torsion, translation and combined mechanisms in connection with the concept of the stabilizing axial spinal pillar. SETTING: Hospital 'Sf. Treime', Iasi, Romania. METHODS: The essential mechanisms of spinal injuries are considered: (1) axial deformation with (a) compression (centric or eccentric), most often eccentric, including compression in flexion or extension; (b) spinal elongation with distraction as centric elongation, but frequently axial eccentric elongation and a flexion or extension injury; (2) torsion or axial spinal rotation, (3) segmental translation, with a shearing version for the double translation and (4) combined mechanisms - the most frequent situation. Over 300 patients with spinal injuries were analysed and the spinal instability was determined using the criteria of clinical instability. The cases of spinal instability were studied in connection with the types of lesion of the central axial spinal pillar. RESULTS: All cases with lesions of the central axial spinal pillar had traumatic spinal instability. The spinal instability was absent in cases of isolated lesions of the anterior or posterior secondary pillar. The X-ray and spinal CT analysis of the traumatic spinal lesions showed the types of lesions and specified the mechanisms of spinal injuries. The combined mechanisms were responsible for the majority of the spinal injuries. CONCLUSIONS: Spinal instability occurs because of the lesion of the central axial spinal pillar The types of lesions of the central spinal pillar and of the secondary spinal pillars are determined by the essential traumatic spinal mechanisms: axial deformation (with compression or elongation), axial rotation, translation and most frequently the above combined mechanisms.

Diagnosis, Differential↗
PubMed2002

An exploration of the occurrence of pressure ulcers in a British spinal injuries unit.

Spinal cord injury (SCI) is associated with increased risk of pressure ulcers, but there are few published data about this in the United Kingdom (UK). This article represents a quantitative exploration of the occurrence of pressure ulcers in a UK spinal injuries unit (SIU). The technique used is a retrospective review of records: details of 144 completed first admissions for SCI between 1998 and 2000 were entered on to a database (SPSS) for analysis. Thirty-two per cent of patients already had pressure ulcers on admission to the SIU, while a total of 56% experienced an ulcer at some stage between injury and discharge from the SIU. Four pressure ulcer risk assessment scales were used (Waterlow, Braden, Norton and SCIPUS-A). These appeared to have moderate predictive power in this population. Pressure ulcers were found to be associated with increased length of hospital stay, density of lesion, surgical stabilization of neck injury before transfer to the SIU, tracheostomy on admission to the SIU and delayed transfer to the SIU after injury. Implications for practice are discussed.

Adolescent↗
PubMed1997

Neurosurgical management of penetrating spinal injury.

BACKGROUND: Penetrating spinal injuries are the third most common cause of spinal cord injury, exceeded only by motor vehicle accidents and falls. The spinal cord can vary from complete destruction to a normal appearing cord. There remains much controversy regarding the neurosurgical management of patients who sustain penetrating injuries of the spine. METHODS: Penetrating spinal injuries account for four to seven new cases of penetrating injury per million persons per annum. The initial management of penetrating spinal injury follows the principles of standard trauma care. Once the patient is hemodynamically stabilized and concomitant life-threatening injuries have been addressed, care can be directed toward the spinal injury. RESULTS: A meticulous neurological examination should be performed, including individual assessment of all muscle groups and sensory dermatomes. This examination becomes the baseline with which all subsequent examinations will be compared. The radiologic examination of the patient begins after all radiographs of higher priority have been obtained. CONCLUSIONS: Penetrating spinal cord injury is associated with significant morbidity. The optimal management for these patients has not been determined, however, spinal instability resulting from the initial missile injury is rare.

Humans↗
PubMed1975

Spinal injuries in children.

Spinal injuries with neurologic sequelae are a rare but catastrophic injury. Many of these injuries might be preventable through proper parent and child education, particularly in water sports and vehicles accidents. A significant number of neurologic injuries are incomplete at the time of injury and proper rescue and initial care may make the difference between life as a quadriplegic and life as a normal individual. Because of the complexity of the management of the child with spinal injuries and their relative rarity, the definitive care is best undertaken at hospitals which specialize in the care of spinal injuries. Progressive deformity of the spine, a problem unique to childhood and adolescent paralysis, is often preventable with prolonged immobilization and protection of the spine. Progressive deformities which interfere with function or result in neurologic deterioration require an aggressive surgical approach.

Accidents, Traffic↗
PubMed2001

Anaesthetic and intensive care aspects of spinal injury.

Over the last few years, spinal injuries have been classified depending upon their causative mechanism and on the basis of three column concept of the structure of vertebral column. The concept of primary and secondary injury has laid more stress on prevention and treatment of secondary injury. Methyl prednisolone still remains the drug of choice for prevention of secondary injury. Spinal injury involves all organ systems of the body depending on the level of lesion. Immobilisation of injured spine and maintenance of adequate airway after spinal injury need immediate attention. Orotracheal intubation under general anaesthesia, with manual in-line traction, is still considered the best method. Hypotension, hypertension and hyperglycaemia should be avoided during anaesthesia. Care should be taken to avoid effects of autonomic hyper reflexia. Spinal cord functions should be monitored and, if required, induced hypotension can be used with adequate monitoring.

Anesthesia↗
PubMed1996

Validation of the American Spinal Injury Association (ASIA) motor score and the National Acute Spinal Cord Injury Study (NASCIS) motor score.

STUDY DESIGN: In this study the motor scores of 62 consecutive acute spinal cord-injured patients were retrospectively reviewed. OBJECTIVE: The reliability of the American Spinal Injury Association and National Acute Spinal Cord Injury Study motor scores, compared with the conventional motor scores, was retrospectively assessed. SUMMARY OF BACKGROUND DATA: The reliability of the American Spinal Injury Association and National Acute Spinal Cord Injury Study scores has not as yet been confirmed. METHODS: Sixty-two consecutive adult patients admitted within 7 days of acute spinal cord injury between April, 1983, and September, 1992, were evaluated. The motor deficit percentage and the motor recovery percentage of each of the American Spinal Injury Association and the National Acute Spinal Cord Injury Study motor scores were compared with those of the conventional motor score. From the initial and final motor score, the motor deficit percentage and motor recovery percentage were calculated. There were 38 patients with cervical and thoracic lesions, 12 patients with dorso-lumbar lesions, and 12 patients with lower lumbar lesions. The average follow-up period was 41 months. RESULTS: Both the American Spinal Injury Association motor score and the National Acute Spinal Cord Injury Study motor score were representative of the conventional motor score for the evaluation of the motor deficit percentage and the motor recovery percentage in all levels (P < 0.0001). The differences in all correlation coefficients between the American Spinal Injury Association motor score and the National Acute Spinal Cord Injury Study motor score were not statistically significant in all levels and in every group. CONCLUSIONS: The American Spinal Injury Association and National Acute Spinal Cord Injury Study motor scores can both be used for the neurological quantification of motor deficit and motor recovery.

Adolescent↗
PubMed2004

Spinal injuries centres (SICs) for acute traumatic spinal cord injury.

BACKGROUND: The majority of complications in traumatic spinal cord injury (SCI) can occur in the first 24 hours and it has been suggested that spinal injury centres (SICs) may influence the pre-transfer care of people with SCI. The specialist SIC concept has been adopted in a number of high-income countries. However, even in such countries, a potentially significant number of people with SCI do not have the opportunity to access this system and are managed in a non-specialist environment. OBJECTIVES: To answer the question: does immediate referral to an SIC result in a better outcome than delayed referral? SEARCH STRATEGY: The following databases were searched: AMED, CCTR, CINAHL, DARE, EMBASE, HEED, HMIC, MEDLINE, NRR, NHS EED, and PsycLIT. Searches were updated in May 2003 and included the Cochrane Injuries Group Specialist Register. The reference lists of retrieved articles were checked. SELECTION CRITERIA: Randomised controlled trials and controlled trials that compared immediate referral to an SIC with delayed referral in patients with a traumatic SCI. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected studies. One reviewer was to have assessed the quality of the studies and extracted data. MAIN RESULTS: No randomised controlled trials or controlled trials were identified that compared immediate referral to an SIC with delayed referral in patients with a traumatic SCI. All of the studies identified were retrospective observational studies and of poor quality. REVIEWERS' CONCLUSIONS: The current evidence does not enable conclusions to be drawn about the benefits or disadvantages of immediate referral versus late referral to SICs. Well-designed, prospective experimental studies with appropriately matched controls are needed.

Hospitals, Special↗
PubMedDate not supplied

Problems in diagnosis and management of hypovolaemia in spinal injury.

Thoracic spinal cord injury can result in hypotension from loss of peripheral vascular tone. There may be problems in both diagnosis and management when this is combined with hypovolaemia from haemorrhage. A case is reported that illustrates these difficulties.

Abdominal Injuries↗
PubMed1986

Liaison psychiatry in a spinal injuries unit.

Spinal cord injury may produce both immediate and long term stress and disability. The liaison psychiatrist may have an important role in dealing with the problems of the spinal cord injured patient, his family and the medical team. Problems occurring may cause or be exacerbated by psychological difficulties. Problems occurring during rehabilitation and long term adjustment have not been systematically studied. Many assumptions concerning the psychological responses to injury have been made. Such assumptions have important implications for both the short and long term treatment of patients. This paper examines some of these areas.

Adaptation, Psychological↗
PubMedDate not supplied

Spinal injuries in skiers and snowboarders.

Spinal injuries are among the most devastating injuries associated with recreational sports. Snowboarding spinal injury patterns have not been described. During two seasons (1994 to 1995 and 1995 to 1996), 34 skiers and 22 snowboarders suffered serious spinal injuries (fracture or neurologic deficit or both) at two ski areas in British Columbia, Canada. Ski patrol records, the Provincial Trauma Database, and hospital records were reviewed. Injury rates were based on computerized lift-ticket data and a population estimate of 15% snowboarders (ski patrol observation). The incidence of spinal injury among skiers was 0.01 per 1000 skier-days, and among snowboarders was 0.04 per 1000 snowboarder-days. Mean age was 34.5 years for skiers and 22.4 years for snowboarders. Seventy percent of the skiers were men, whereas all of the snowboarders were men. Jumping (intentional jump > 2 meters) was the cause of injury in 20% of skiers and 77% of snowboarders. Neither age nor sex accounted for any significant portion of this difference. The rate of spinal injuries among snowboarders is fourfold that among skiers. Although jumping is the primary cause of injury, it is an intrinsic element of snowboarding. Until research defines effective injury-prevention strategies, knowledge of the risk of snowboarding should be disseminated and techniques for safe jumping should be taught.

Adolescent↗
PubMed1989

[Spinal injury in children].

We reported five cases of children with spinal injuries. Spinal injuries are rare in children, and most common from the occiput to C3 in children younger than 8 years. In our cases, two younger children had upper cervical lesions and two older children had lower lesions. These differences result from anatomical characteristics, such as special histological architecture of the growth zones in younger children. One patient had a delayed onset paraplegia without radiographic abnormality. This phenomenon seems to be one of the characteristics of the spinal injuries in children. Because of this, all children with head or neck injuries should be fully investigated. A nine-month-old child who suffered from a fracture of the odontoid process with atlantoaxial dislocation was treated by immobilization only, and the result was good. Generally, fracture of the odontoid process in young children can be treated by proper immobilization. One patient with fracture dislocation of the cervical spine died as a result of cord injury. So immediate surgical decompression is mandatory for patients with evidence of cord compression.

Adolescent↗
PubMed2026

Treatment of spinal injury muscle spasticity by spinal subpial AAV9-GAD65/VGAT delivery: An efficacy and safety study in rat, pig, and NHP.

The loss in segmental inhibitory GABAergic tone plays the key role in the development of spinal injury-induced muscle spasticity. We use a subpial segment-targeted delivery of adeno-associated virus vector(s) expressing GAD65 (glutamic acid decarboxylase-65) and VGAT (vesicular GABA transporter) transgenes in rats with spinal transection-induced spasticity. In treated animals, a significant suppression in spasticity was seen at 5-8 weeks after treatment. Naive rats, pigs, and non-human primates (NHPs) injected with human equivalent dose of treatment vectors and surviving for 3 weeks to 4.5 years showed normal motor function and pinch-evoked response. A significant increase in the number of VGLUT2 terminals co-expressing GAD65 and VGAT protein in vector-injected segment was seen. This corresponded with the presence of transgene-specific rat Gad2 or human GAD2 and rat Slc32a1 or human SLC32A1 mRNA signal. No spinal toxicity was noted in NHPs at 4.5 years post vector delivery. Analysis of peripheral organs (liver, spleen, and skeletal muscle) showed minimal or no detectable transgenes in pigs and NHPs. These data demonstrate that a single-time-point spinal-segment-targeted subpial delivery of GAD65/VGAT transgenes is effective in suppressing spinal injury-induced spasticity and has a favorable long-term safety profile as defined by normal neurological function and histopathology in naive pigs and NHPs.

Animals↗
PubMed2004

Tracheostomy placement in patients with complete cervical spinal cord injuries: American Spinal Injury Association Grade A.

OBJECT: The authors sought to identify variables that predispose patients with acute American Spinal Injury Association (ASIA) Grade A cervical spinal cord injury (SCI) to require tracheostomies for ventilator support or airway protection. METHODS: A retrospective analysis was performed of 178 consecutive patients with a cervical ASIA Grade A SCI who were admitted through the Delaware Valley SCI Center at Thomas Jefferson Hospital during a 6-year period. Exclusion criteria included injury occurring more than 48 hours prior to admission, death within 14 days of admission or nontraumatic SCI. Twenty-two patients were excluded based on these criteria. Parameters evaluated in the remaining population (156 patients) included demographics, cervical vertebral ASIA level, tracheostomy placement, pneumonia, premorbid pulmonary disease, smoking history, evidence of direct thoracic/lung trauma, operative intervention, associated appendicular trauma, and preexisting medical comorbidities. The ASIA classification of the 156 patients included in this analysis were C-2 (eight), C-3 (11), C-4 (64), C-5 (36), C-6 (20), C-7 (13), and C-8 (four). Tracheostomies were performed in 107 of these 156 patients. Statistical analysis revealed a significant relationship between tracheostomy and patient age (p = 0.0048), preexisting medical conditions (p = 0.0417), premorbid lung disease (p = 0.0177), higher cervical ASIA level (p < 0.0001), and the presence of pneumonia (p < 0.0001). No patient with a C-8 ASIA A injury required tracheostomy, whereas all C-2 and C-3 ASIA A-injured patients underwent tracheostomies. Patients older than 45 years of age with ASIA A levels between C-4 and C-7 more commonly required tracheostomy (p < 0.005) than patients younger than 45 years of age. CONCLUSIONS: Several risk factors were identified that corresponded to the frequent tracheostomy placement in the acute injury phase after complete cervical SCI. Early tracheostomy may be considered in patients with multiple risk factors to reduce duration of stay in the intensive care unit and facilitate ventilatory weaning.

Adolescent↗