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At least 613 records · Page 34Linked to original sources
PubMed1984

The fertility of men with spinal injuries.

Application of a vibrator of 80 Hz and 2.5 mm amplitude to the lower surface of the glans penis caused ejaculation in less than 20 minutes (usually less than 3 minutes) in 48 of 81 men with spinal cord injuries (mostly complete) of more than 6 months duration. It failed in all the 19 of the 81 who lacked reflex hip flexion on scratching the soles of the feet, and in 14 others. It failed in 11 of 12 men with injuries of less than 6 months' duration. From 21 of 34 men for whom the vibrator failed, semen could be obtained by electroejaculation, which is just as successful within 6 months of injury as subsequently and may succeed even if reflex hip flexion is absent. Eleven pregnancies where the father had a complete or nearly complete spinal cord lesion are reported. Nine healthy children have been born.

Adult↗
PubMed2003

Acute neurosurgical management of traumatic brain injury and spinal cord injury.

PURPOSE OF REVIEW: This review discusses some of the recent advances and current controversies in the acute clinical management of traumatic brain injury (TBI) and spinal cord injury (SCI). RECENT FINDINGS: Several key risk factors for adverse prognosis in TBI have been identified, including female sex. In the management of intracranial hypertension antibiotic impregnated intraventricular catheters have been found to reduce the risk for infection, and new studies have examined the roles of mannitol, hyperventilation, and hypothermia. Moderate hypothermia has also been found to improve outcome. Hyperoxia is now being explored as a treatment option for improving brain metabolism in TBI. That acute SCI continues to be a challenging diagnosis is supported by a recent study that showed that 9.1% of SCIs are missed initially. The diagnosis and management of spinal instability has been studied in different patient groups. In SCI without radiographic abnormality, the presence of normal magnetic resonance imaging findings was associated with a good prognosis. New studies in the field of early decompression and the prevention of thromboembolism in SCI have also been published. Guidelines for the management of acute SCI recommend methylprednisolone and GM-1 ganglioside only as options. SUMMARY: In neurotrauma some established treatments have been re-examined and their efficacy proven, whereas others that were once considered the standard of care in SCI, such as methylprednisolone, have been questioned. Large multicenter trials are needed to assess treatments such as early decompression in SCI and decompressive craniectomy in TBI. A truly effective neuroprotective therapy in neurotrauma remains elusive.

Acute Disease↗
PubMed2000

Spinal injuries at the University Hospital of the West Indies.

Acute spinal damage forms a small percentage of total trauma injury but it has tremendous significance because of the resultant disability, poor prognosis, economic and social cost and the burden on victims, family, taxpayers and health workers. Of fifty-five patients admitted to the University Hospital of the West Indies (UHWI), Mona, Jamaica, over a seven-year period, forty form the basis of this report. Young males accounted for most victims and 85% of the injuries were non-intentional. The cervical spine, most commonly C6, was the region most frequently injured, followed by the lumbar and the thoracic regions. On admission, the mean Glasgow Coma Score was 14.6 and the mean Modified Injury Severity Score 12.7. Five patients were admitted in Frankel Grade A, complete paraplegia. Of eighteen patients treated with steroids, only eleven had methylprednisolone and only six of these appropriately. Nine patients had surgery after a mean time of 10.1 days. The average length of hospital stay was 18.2 days. Of 35 patients whose outcomes were known, eleven improved; two patients died in hospital. With the modernization of the management of this condition, we recommend that attention be focused on prevention, pre-hospital immobilization and transport, prompt resuscitation, the standardization of written protocols and early operative intervention. Also essential is the continuing medical education of all levels of personnel and the formalization of a well-coordinated and rehearsed Spine team.

Adolescent↗
PubMedDate not supplied

A new system of classification for spinal injuries.

BACKGROUND CONTEXT: A comprehensive classification for spinal trauma has proved difficult to achieve as attested to by the number of systems in use today. In addition, few systems can be applied to all levels of the spine, and the first two cervical vertebrae are usually treated as altogether separate from the remainder of the spine. Consequently, outcome data and comparison of published data are difficult, at best. PURPOSE: The purpose of this presentation is to introduce a new system for classification of spine trauma applicable to all levels of the spine. STUDY DESIGN/SETTING: A different way of viewing the vertebrae is proposed. It allows the inclusion of all levels of the spinal column in a unified classification system based on the morphology of the injury. Each vertebra is viewed as a bony ring, and the rings are linked, above and below, by three osseoligamentous structures. These are the end plate-disc-end plate anteriorly and the facet joints posteriorly. Equivalent structures for the links are defined for the atlas and axis. PATIENT SAMPLE: The x-rays and computed tomographic or magnetic resonance imaging of patients with spine trauma were used to apply this classification to acute injuries. The sample used was all patients with spine trauma admitted, during a 1-year period, to a level 1 trauma center. Not all the patients were treated by the author, and no attempt was made to determine indications for treatment or treatment outcomes on the basis of this new classification system. METHODS: A new classification retrospectively applied to a defined patient population, which appeared to be representative of known trauma patterns. RESULTS: All patients with spinal trauma in this patient population were classifiable by this new system. All fracture types proposed in this system were represented in the patient sample. CONCLUSION: This new classification system appears to warrant further study.

Cervical Vertebrae↗
PubMed1992

An electromechanical spinal injury technique with dynamic sensitivity.

Over the past decade, our laboratory has attempted to create a simple, accurate device that could be used to produce reliable and quantifiable spinal cord injuries in the rodent. We report here on our latest of several modifications of a spinal cord impactor that has allowed us to meet these design criteria. The impactor uses the dynamic capacity of an electromagnetic driver (Ling shaker) and a unique pattern generator to briefly compress the dorsal surface of the spinal cord at velocities that may mimic compression injuries seen in the human. Calibrated, independent transducer systems provide open-loop output of the precise movement (displacement) of the impactor probe and the force necessary to achieve a given displacement. Touch sensitivity is accomplished by vibrating the probe slightly as it approaches the dural surface. This also allows a known biomechanical starting point. This combination of improvements in sensitivity and ability to measure all components of the dynamic compression has allowed us to determine detailed biomechanical descriptors of these impact injuries with low coefficients of variation. Furthermore, such descriptors correlate highly with histopathologic and behavioral outcome measures in animal populations with a variety of injury severities.

Animals↗
PubMed1989

Stabilization of spinal injury for early transfer.

We have reviewed the means of transport and type of stabilization used for all patients with acute spinal cord injuries (SCI) transferred to our center since 1985 to determine what effect these variables may have had on change in level of impairment and probability of neurologic improvement after arrival. Sixty-one patients were reviewed, 47 males and 14 females, with a mean age of 34 years. Twenty-five patients (41%) were transported by ground ambulance, 33 (54%) by helicopter, three (5%) by fixed-wing aircraft. Forty-three patients (70.5%) had cervical spine injuries, 11 (18%), thoracic spine injuries, and seven (11.5%), lumbar spine injuries. Fifty-one patients (84%) were transferred within 24 hours of injury. A variety of standard methods of stabilization were used during transport. No patient suffered ascending level of injury as a result of early transfer. Level of function improved before discharge in 26 of 61 patients (43%); patients transported within 24 hours were more likely to show improvement (25/51) than those transported after 24 hours (1/10). There was no significant difference in the probability of improvement between ground (8/25) or air (18/36) transport. Skeletal traction was used before transfer in only four of 43 patients with cervical spine injuries, and was maintained as a method of long-term stabilization in two patients. We conclude that acute SCI patients can be safely transported by air or ground using standard precautions. Distance and extent of associated injury are the best determinants of mode of transport. Skeletal traction does not appear to be a prerequisite for safe, early transfer of SCI patients.

Adolescent↗
PubMed2006

Memokath stents for the treatment of detrusor sphincter dyssynergia (DSD) in men with spinal cord injury: the Princess Royal Spinal Injuries Unit 10-year experience.

STUDY DESIGN: Medical records review. OBJECTIVE: To assess the effectiveness of the Memokath (Engineers and Doctors A/S, Denmark) thermosensitive stent as a 'nondestructive' means of reducing bladder outlet resistance by treating detrusor sphincter dyssynergia (DSD) of neurogenic bladder dysfunction associated with spinal cord injury. SETTING: Spinal Injuries Unit, Sheffield, England. METHODS: A medical records review was performed to examine our experience of Memokaths over the last 10 years. During this time, 29 patients with spinal cord injury (17 tetraplegic and 12 paraplegic) underwent stenting of the external urethral sphincter either for prevention of dysreflexic symptoms, high residual urine volumes and subsequent urinary tract infection (UTI) or for protection of the upper tracts. RESULTS: A total of 33 stents were inserted into 29 men (25-77 years) with suprasacral spinal cord injury. Initial results showed that the Memokath was effective in almost all for relief of dysreflexic symptoms and elimination of DSD on pressure flow urodynamics. However, to date, 30 of the 33 stents have been removed. The overall mean working life of the Memokath was 21 months. Four stents were removed electively and 23 for complications, which included stent migration (seven) and blockage (14). Single-ended stents were more prone to migration, which was rare after 1 year (1-13 months, median 3 months, mean 5.5 months). Stent blockage by encrustation or prostatic ingrowth did not occur before 12 months (12-45 months, median 30, mean 27.9 months). CONCLUSIONS: In selected patients, temporary, thermo-expandable (Memokath) stents are effective in the treatment of DSD. The 'working life' of a Memokath stent is 21 months; however, complications do occur which may necessitate removal. Our overall experience with Memokath stents was disappointing. In future, Memokath stents will only be inserted after careful consideration in patients with prior 'failed' transurethral sphincterotomy or with caution in patients suitable for reconstructive surgery.

Adult↗
PubMed1993

Effect of flunarizine and methylprednisolone on functional recovery after experimental spinal injury.

The effect of flunarizine and methylprednisolone on the recovery of somatosensory evoked potentials (SEPs) was evaluated in an experimental model of spinal cord impact injury in anesthetized cats. In addition, the effect of flunarizine on posttraumatic spinal cord blood flow (SCBF) (using the hydrogen clearance technique) and interstitial calcium and potassium activity (ion-selective electrodes) was investigated. After the injury (600 g.cm), SEPs disappeared, followed by a spontaneous recovery to 17% of the preinjury amplitude at the end of the 4 h observation period. Flunarizine treatment (0.1 mg/kg IV, given 5 and 120 min after injury) resulted in a significantly improved recovery of SEPs, reaching 52% of the preinjury amplitude. Methylprednisolone treatment (30 mg/kg IV, given 5 min after injury) resulted in a 30% recovery level, significantly better than in untreated animals but significantly inferior to flunarizine treatment. Combination of both treatments resulted in a 62% recovery level, significantly better than after methylprednisolone treatment alone. Flunarizine treatment had no significant effect on the postinjury evolution of SCBF and interstitial potassium activity; it did, however, significantly accelerate the recovery of interstitial calcium activity, which sharply decreased immediately after injury. It is concluded that intravenous administration of the calcium entry blocker flunarizine improves the functional recovery of the spinal cord in the acute phase after experimental spinal impact injury. The observed improvement is not achieved by an effect on local blood flow but is possibly related to an inhibitory effect of the drug on cellular calcium entry.

Animals↗