Somatosensory evoked potential changes in spinal injury and during intraoperative spinal manipulation.
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Evoked Potentials, Somatosensory↗
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Pediatric spinal injury: review of 61 deaths.
Injury to the spinal column and spinal cord occurs relatively infrequently in the pediatric population. The authors present a unique review of 61 pediatric deaths associated with spinal injury. This group represented 28% of the total pediatric spine-injured population and 45% of the total pediatric spinal cord-injured group studied. The ratio of pediatric to adult spinal injury mortality was 2.5:1. Of the 61 children, 54 (89%) died at the accident scene. Thirty patients underwent a complete autopsy, 19 of whom had an Abbreviated Injury Scale Grade 6 injury (maximum score, untreatable). Spinal cord injury was found to be the cause of death in only eight children and was associated with injury to the high cervical cord and cardiorespiratory arrest. These children typically sustained severe multiple trauma. In this population, there appears to be little room for improved outcome through changes in treatment strategy.
Adolescent↗
Spinal injuries in Rangoon, Burma.
Spinal injuries in Burma as a result of a fall from height, especially from trees, in young male adults in low socio-economic classes; road traffic accidents are the second commonest cause; deep vein thrombosis and pulmonary embolism is very rare during the period of immobilisation. There are still some social problems of getting back to work and living conditions. We are trying our best to help the patients with spinal injuries.
Accidents, Occupational↗
The onset and progression of spinal injury: a demonstration of neutral zone sensitivity.
Spinal injuries are a great cost to society and the afflicted individuals. It is well known that most spinal injuries are not bony fractures but rather soft tissue lesions falling in the 'subfailure' region. For the clinical diagnosis of spinal injuries, abnormal motion patterns under physiological loads are considered an important factor. The purpose of the present study was to determine the onset and progression of spinal injury, and compare the sensitivity of three motion parameters: neutral zone (NZ), elastic zone (EZ), and range of motion (ROM). Spinal injury was defined as a significant increase in any of the three motion parameters. A repeatable high-speed flexion-compression load vector was applied individually to six porcine cervical spine specimens. Several impacts of increasing severity were applied to each specimen. After each impact, flexion-extension motion was measured. Neutral zone was the residual deformation from the neutral position to the position under zero load at the start of the final load cycle. Elastic zone was the displacement from zero load to the maximum load on the final load cycle. Range of motion was the sum of the neutral and elastic zones. The first significant increase in motion was determined by the neutral zone parameter with few observable anatomic lesions on the specimens. This was the onset of spinal injury. The next significant motion increase was also determined by the neutral zone parameter. After this motion increase, termed the progression of injury, ligament ruptures were observed in some specimens. It was concluded that the neutral zone was the most sensitive motion parameter in defining the onset and progression of spinal injury.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Gastrointestinal bleeding in patients with acute spinal injuries.
439 acute, male, spinal injury patients were admitted over an 11-year period at the National Spinal Injuries Centre: 206 cervical, 182 dorsal, and 51 lumbar cord injuries. 27 patients had gastrointestinal bleeds; 20 bled on one occasion, 7 had more than one episode; 22 bled within 4 weeks of injury. The mean was 22.5 days. The presentation was mostly malaena. A diagnosis was made in 19 cases; 12 had duodenal ulcers, 4 gastric ulcers, 1 had gastritis, 1 had a gastric carcinoma, 1 had oesophagitis with a possible Mallory-Weiss tear; 4 died. The incidence was higher in cervical patients. Causation was thought to be due to patients being sick from severe intercurrent illnesses and injuries. Implications for further research are discussed.
Acute Disease↗
[Spinal injuries in children and adolescents].
PURPOSE OF THE STUDY: Spinal injuries in children are rare and account for a low proportion of all childhood injuries. Due to anatomical and biomechanical properties of the growing spine, there are great differences between spinal injury in childhood and adulthood. Because of higher mobility and elasticity of the spine and a lower body mass in children, spinal injuries are not frequent and represent only 2 to 5 % of all spinal injuries. In this retrospective study, the effectiveness of conservative and surgical treatment of injured spines in children is evaluated in a 10-year period. MATERIAL: All patients from birth to the completed 18th year of age treated in our departments between 1996 and 2005 were included in this study. The patients, evaluated in three age categories (0-9, 10-14, 15-18), were allocated to two groups according to the method of treatment used (conservative or surgical). The information on patients treated conservatively was drawn from medical records; the surgically treated patients were invited for a check-up. METHODS: We used conservative treatment in patients with stable spinal injury who had no neurological deficit and in patients with neurological deficit but without apparent injury to the skeleton. Surgery was indicated in patients with unstable spinal injury and in those with neurological deficit and apparent injury to the skeletal structures. Injuries to the cervical spine were treated conservatively using a Philadelphia collar or a halo-vest in more serious cases. For treatment of injury to the thoracolumbar spine, the Magnuson method was preferred, together with rest in bed until subsidence of acute pain, followed by application of a vest and active rehabilitation to strengthen postural muscles. When surgery was used, the procedure was selected on a strictly individual basis in patients under 12; in older patients it was carried out according to the adult treatment protocol. RESULTS: During 1996 through 2005, we treated a total of 15 646 patients with injury to the skeleton, aged 0 to 18 years. The spine was affected in 571 cases, which is 3.6 %. We used conservative treatment in 528 (92.5 %) and surgery in 43 (7.5 %) children. The period between surgery and evaluation ranged from 6 to 120 months (average, 46.3 months) in the patients treated conservatively, and from 6 to 66 months (average, 27 months) in the surgically treated patients. The group of patients treated conservatively consisted of 292 boys (55. 3 %) and 236 girls (44.7 %); of these 219 (41.5 %) were in the 0-9 year category, 251 (47.5 %) were between 10 and 14 years and 58 (11 %) were 15 to 18 years old. The average age in this group was 10.2 years. The most frequent cause of injury was a fall (277; 52.2 %), then sports activity or games (86; 16.3 %), car accidents (34; 6.4 %) and diving accidents (30; 5.7 %). Pedestrians were injured on 25 occasions (4.7 %) and other causes of injury were recorded in 76 patients (14.4 %). In all age categories, injury to the thoracic spine was most frequent (340; 64.4 %). Three and more vertebrae were injured (multi-segment injury) in 124 patients (23.5 %). The thoracolumbar spine was affected in 22 patients (4.2 %), and lumbar vertebrae were injured in 28 patients (5.3 %). Injury to the cervical spine, both upper and lower, was least frequent, including four (0.8 %) and 10 (1.9 %) patients, respectively. None of the patients in this group showed neurological deficit. The surgically treated group included 29 (67.4 %) boys and 14 (32.6 %) girls; two (4.7 %) children were between 0 and 9 years, nine (20.9 %) between 10 and 14 years, and 32 (74.7 %) between 15 and 18 years, with an average of 15.1 years for the whole group. The frequent causes of injury were car accidents and falls in 21 (48.8 %) and 14 (32.6 %) children, respectively. Other causes were infrequent. The upper cervical spine was operated on in five (11.6 %), lower cervical spine in eight (18.6 %), thoracic spine in 13 (30.2 %), thoracolumbar spine in five (11.6 %) and lumbar vertebrae in 12 (27.9 %) patients. Thirty-six (83.7 %) patients had fractures, five had dislocated fractures (11.6 %) and two (4.7 %) had a dislocation. Of the 43 children in this group, neurological deficit was recorded in nine (20.9 %); this included a complete spinal cord lesion, an incomplete spinal cord lesion and a nerve root lesion in three, five and one patient, respectively. DISCUSSION: The results of this study confirm, in the majority of aspects, the conclusions of previously published papers. In some of the characteristics described above, however, our results are different, which can be explained by some specific features of care for injured children in the Czech Republic. CONCLUSIONS: Childhood spinal injuries account for only 2 to 5 % of all spinal injuries and for 3.6 % of all skeletal injuries in children. Particularly at the age of 11 to 12 years, they differ significantly from spinal injuries in adults and therefore require different therapeutic approaches. The cervical spine is affected most often in younger children, while the thoracolumbar spine in older children. Multi-segment injuries are typical in the childhood spine, particularly in smaller children. Typically, children show SCIWORA and a more rapid improvement of neurological deficit than adults. Conservative treatment is preferred; surgery before 12 years of age is strictly individual, while after 12 years therapy is similar to that used in adults.
Adolescent↗
[Spinal injuries with damage to the spinal cord].
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Humans↗
[Immunological changes in the organism in spinal injuries with damage to the spinal cord].
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Antibody Formation↗
Spinal stabilization in acute spinal injuries.
Stabilization of acute spinal injuries is of prime importance in prevention of further neurologic compromise, prevention of late spinal deformity with associated risk of neurologic compromise, prevention of painful pseudarthrosis, and in maximizing rehabilitation. Many questions regarding the best care and stabilization of the injured spine, particularly those associated with spinal cord injury, remain unanswered. Certainly a diversity of opinion regarding these issues exists between various centers throughout the country today. Hopefully the development of the Regional Spinal Cord Injury Center concept will allow collection of clinical data sufficient to standardize care of these patients in the future.
Cervical Vertebrae↗
Paramedic use of a spinal injury clearance algorithm reduces spinal immobilization in the out-of-hospital setting.
OBJECTIVE: To determine whether paramedics can safely use a spinal clearance algorithm to reduce unnecessary spinal immobilization (SI) in the out-of-hospital setting. METHODS: Paramedics were instructed in the use of a spinal clearance algorithm that prompted assessment of the trauma patient's 1) level of consciousness, 2) drug and/or alcohol use, 3) loss of consciousness during the event, 4) presence of spinal pain/tenderness, 5) presence of neurologic deficit, 6) concomitant serious injury, or 7) presence of pain with range of motion. The algorithm indicated that if any of the above were present, the patient should receive full SI, and if all of the above were negative, then SI could be withheld. Paramedics completed a tracking form that included the above and followed the patient to the emergency department (ED). Data were then gathered to determine the presence of spinal fracture, neurologic deficit, or a combination of the two. To compare the trends for SI, a retrospective medical incident report (MIR) review was conducted from the previous year. MIRs were selected based on the same criteria as those used for study inclusion. RESULTS: Two hundred eighty-one patients were included in the study, with 65% (n = 183) of them receiving SI. Two hundred ninety-three MIRs were included in the retrospective sample, with SI being provided 95% (n = 288) of the time. Comparison of these samples shows a 33% reduction in utilization of SI (95% confidence interval: 27.2%- 38.8%). CONCLUSION: An out-of-hospital spinal clearance algorithm administered by paramedics can reduce SI by one-third. Any application of a spinal clearance algorithm should be accompanied by rigorous medical supervision.
Adolescent↗
CT scanning of spinal injuries.
Ninety-one patients with spinal injuries were studied by CT scanning. A comprehensive classification of spinal injuries was proposed according to the mechanism of trauma, the concept of three-column anatomical structure of the spine and the degree of spinal canal stenosis. CT scanning was advantageous in the diagnosis of spinal injuries such as clear detection of the three-column anatomical structure of the spine and spinal canal, demonstration of fracture lines in all 3 planes, determination of the amount of displacement of bony fragment into the spinal canal, assessment of spinal stability or instability, and restricted movement of the patient. The key points in general CT diagnosis, its role and limitation in the diagnosis of spinal injuries were discussed. The authors conclude that combined comprehensive classification of spine injuries is helpful in planning suitable treatment for the patient and predicting prognosis.
Adolescent↗
The reliability of prehospital clinical evaluation for potential spinal injury is not affected by the mechanism of injury.
INTRODUCTION: Traditional EMS teaching identifies mechanism of injury as an important predictor of spinal injury. Clinical criteria to select patients for immobilization are being studied in Michigan and have been implemented in Maine. Maine requires automatic immobilization of patients with "a positive mechanism" clearly capable of producing spinal injury. OBJECTIVE: To determine whether mechanism of injury affects the ability of clinical criteria to identify patients with spinal injury. METHODS: In this multicenter prospective cohort study, EMS personnel completed a check-off data sheet for prehospital spine-immobilized patients. Data included mechanism of injury and yes/no determinations of the clinical criteria: altered mental status, neurologic deficit, evidence of intoxication, spinal pain or tenderness, and suspected extremity fracture. Hospital outcome data included confirmation of spinal injury and treatment required. Mechanisms of injury were tabulated and rates of spinal injury for each mechanism were calculated. The patients were divided into three different high-risk and low-risk groups. RESULTS: Data were collected for 6,500 patients. There were 209 (3.2%) patients with spinal injuries identified. There were 1,058 patients with 100 (9.4%) injuries in the first high-risk mechanism group, and 5,423 patients with 109 (2%) injuries in the first low-risk group. Criteria identified 97 of 100 (97%) injuries in the high-risk group and 102 of 109 (94%) in the low-risk group. Two additional data divisions yielded identical results. CONCLUSION: Mechanism of injury does not affect the ability of clinical criteria to predict spinal injury in this population.
Adult↗
Multilevel spinal injuries. Incidence, distribution and neurological patterns.
Spinal injury at more than one level is not uncommon. Awareness of multilevel injury of the spine and associated neurological patterns is important for the proper initial management of the patient. This study presents the incidence, pattern of signs and the neurological consequences of multilevel spinal injury. A review of 935 patients with spinal injuries revealed that lesions occurred in multiple levels in 9.7%; in over half of the cases, neurological lesions were incomplete. Multiple level non-contiguous lesions at more than two levels had the worst prognosis with 70% of patients suffering complete paraplegia.
Fractures, Bone↗
Spinal injuries in Scottish mountaineers.
OBJECTIVE: To identify the frequency and pattern of spinal injury sustained in mountaineering accidents. METHODS: All patients with spinal injuries sustained while mountaineering who were treated at the Queen Elizabeth National Spinal Injuries Unit from 1992 to 2001 were studied. Information was obtained from hospital notes, and each patient completed a questionnaire. RESULTS: Twenty-one patients with spinal injuries sustained in mountaineering accidents were identified. Fourteen patients (67.7%) were experienced mountaineers. Four (19.0%) were rock climbing, 6 (28.6%) were winter climbing, 6 (28.6%) were hill walking, and 5 (23.8%) were winter walking. Ten patients (47.6%) sustained cervical injuries, 5 (23.8%) sustained thoracic injuries, 5 (23.8%) sustained lumbar injuries, and 1 (4.8%) sustained cervical and lumbar injuries. Nineteen patients (90.5%) sustained fractures, 1 (4.8%) sustained a dislocation, and 1 (4.8%) sustained a fracture dislocation. Seventeen patients (81.0%) were neurologically intact, 2 (9.5%) sustained complete cord injury, and 2 (9.5%) sustained incomplete cauda equina lesions. Ten patients (47.6%) required internal fixation of their fractures. Fourteen patients (57.1%) sustained other significant injuries. CONCLUSIONS: This is the first study specifically aimed to describe patterns of spinal injuries and their outcomes in mountaineers. The group we studied had sustained fractures at differing spinal levels with no specific injury pattern. The incidence of cord injury was lower than in other spinal injury patient groups. The majority had also sustained other significant and potentially distracting injuries. Prehospital care providers should maintain a high suspicion of spinal injury in this group.
Adolescent↗
Evaluation and treatment of spinal injuries in the patient with polytrauma.
Spinal injuries occur frequently in the patient with polytrauma making the knowledge of the evaluation and treatment of these injuries invaluable to the trauma team. In the immediate moments after these injuries, critical steps can be taken to prevent additional injury and insure maximum neurologic and functional recovery of the patient. A simple, standardized approach to treating the patient at the scene, examining the patient in the trauma admitting area, ordering appropriate radiographic studies, and instituting early treatment can markedly influence a patient's maximal recovery. Furthermore, background knowledge in the classification and ultimate treatment goals allows for an effective communication between the initial treating team and the spinal surgeons involved. The work on indicators of potential spinal instability by White and Panjabi and the three-column classification of spinal injuries of Denis lends insight to the potential consequences of spinal trauma. A thorough appreciation of these concepts puts evaluation and treatment of these injuries into a logical framework with which spinal injuries initially can be approached.
Cervical Vertebrae↗
Association between deep vein thrombosis (DVT) and heterotopic ossification.
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Humans↗
Transgenic inhibition of Nogo-66 receptor function allows axonal sprouting and improved locomotion after spinal injury.
Axon growth after spinal injury is thought to be limited in part by myelin-derived proteins that act via the Nogo-66 Receptor (NgR). To test this hypothesis, we sought to study recovery from spinal cord injury (SCI) after inhibiting NgR transgenically with a soluble function-blocking NgR fragment. Glial fibrillary acidic protein (gfap) gene regulatory elements were used to generate mice that secrete NgR(310)ecto from astrocytes. After mid-thoracic dorsal over-hemisection injury, gfap::ngr(310)ecto mice exhibit enhanced raphespinal and corticospinal axonal sprouting into the lumbar spinal cord. Recovery of locomotion is improved in the gfap::ngr(310)ecto mice. These data indicate that the NgR ligands, Nogo-66, MAG, and OMgp, play a role in limiting axonal growth in the injured adult CNS and that NgR(310)ecto might provide a therapeutic means to promote recovery from SCI.
Animals↗
Current concepts: spinal injuries and rehabilitation.
Spinal cord injuries and their catastrophic effects require a treatment infrastructure able to provide an integrated process of management, including rehabilitation from injury and on an ongoing basis. This is particularly important because the incidence of spinal cord injuries is small. Better outcomes and cost efficiency with such an infrastructure have been established, but further knowledge is required to solve the remaining controversies in some aspects of management.
Humans↗