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At least 109 records · Page 6Linked to original sources
PubMed1994

Motorcycle helmets and spinal injuries: dispelling the myth.

STUDY OBJECTIVE: To determine the relationship between spinal injuries and helmet use in motorcycle trauma. DESIGN: Retrospective case series. SETTING: Twenty-eight hospitals in four midwestern states--Illinois, Iowa, Nebraska and Wisconsin--representing urban, suburban, and rural settings. PATIENTS AND OTHER PARTICIPANTS: Consecutive sample of motorcyclists treated at the participating centers. INTERVENTIONS: None. MAIN OUTCOME MEASURES: The major variables evaluated were helmet use, ethanol use, and significant head or spinal injuries. RESULTS: 1,153 cases were analyzed. Helmet use was not significantly associated with spinal injuries (odds ratio, 1.12; 95% confidence intervals, 0.79, 1.58) whereas head injury was markedly decreased with helmet use (odds ratio, 0.35; 95% confidence intervals, 0.23, 0.53). Ethanol use was a significant variable in both head (odds ratio, 3.89) and spinal (odds ratio, 2.41) injuries. CONCLUSION: In contrast to a significant protective relationship identified for head injuries, helmet use was not associated with an increased or decreased occurrence rate of spinal injuries in motorcycle trauma.

Adult↗
PubMed2002

Spinal injuries in motorcycle crashes: patterns and outcomes.

BACKGROUND: The purpose of this study was to determine patterns of spinal injury and clinical outcomes resulting from motorcycle crashes. METHODS: We analyzed data collected on 1,121 motorcyclists involved in road traffic accidents (from 1993-2000) and identified those who had sustained a spinal injury. RESULTS: Spinal injury occurred in 126 (11.2%) riders (112 male riders [88.9%] and 14 female riders [11.1%]), with a mean age of 30.2 years (range, 16-61 years) and Injury Severity Score of 18.8 (range, 4-66). Isolated injuries to the spine occurred in 30 (23.8%) riders. The thoracic spine was injured in 69 (54.8%), the lumbar spine in 37 (29.4%), and the cervical spine in 34 (27.0%) cases. Multiple vertebral levels were affected in 54 (42.9%). Neurologic injury occurred in 25 riders (19.8%), with complete distal neurologic injury in 14 (4 cervical, 9 thoracic, and 1 lumbar). Eleven (8.7%) patients required spinal surgery. There were 13 (10.3%) deaths. CONCLUSION: The thoracic spine is the most commonly injured spinal region in motorcycle crashes. Multiple level injuries are common. Protocols concentrating on the radiographic clearance of the cervical region may miss a significant number of spinal injuries. Vigilance is required in assessing these patients, who often have multiple injuries.

Accidents, Traffic↗
PubMed1990

Antibody coated bacteria in urine of patients with recent spinal injury.

Twenty patients with an acute spinal injury were prospectively studied to assess the clinical importance of antibody coated bacteria (ACB) in the urine and the association among the different bacterial species with a positive antibody coated bacteria test. Clinical urinary tract infection was associated with a positive ACB test on 45% of occasions. Three hundred and ninety nine urine samples containing 541 bacterial isolates were assessed for the presence of ACB; 13% were found to be positive and 87% negative for ACB; 67% of urines contained a single bacterial isolate. Pseudomonas aeruginosa was most commonly associated with clinical urinary tract infection, found in 25% of episodes, followed by Proteus mirabilis (17.5%), Klebsiella sp (12.5%), and Proteus morganii (10%). Providencia stuartii, however, was most commonly associated with a positive ACB test (found in 17%). Other bacteria associated with a positive ACB test included Klebsiella sp (14%), Acinetobacter sp (12.5%), Pseudomonas aeruginosa (12%), Citrobacter sp (11.5%). A positive ACB test is not to be expected from a patient with spinal injury who has a catheter in place, and the test may provide a useful guide to identify those patients with an invasive infection. It is doubtful that a decision to treat or not treat bacteriuria could rest on the identification of the bacterial species alone.

Acute Disease↗
PubMed2001

[Pharmacologic stimulation of ejaculation with midodrine hydrochloride (Gutron) for medically assisted reproduction in spinal injury].

INTRODUCTION: Midodrine hydrochloride (Gutron) is proposed to induce ejaculation in spinal injury patients desiring paternity as an alternative to vibromassage, electrostimulated ejaculation and surgical collection of spermatozoa. The authors report their experience in 10 spinal injury patients. PATIENTS AND METHODS: 14 trials of pharmacologically-induced ejaculation were performed in a context of medically assisted reproduction (MAR) in 10 spinal injury patients (7 with paraplegia > T11; 1 with paraplegia < or = T11; 2 with quadriplegia) an average of 4.5 years after the injury. Patients had a mean age of 28.5 years (range: 18 to 36 years). Nine had persistent reflex erections. After IC injection of prostglandin E, 10 to 30 mg of Gutron was administered by slow i.v. infusion. Spermatozoa were collected during antegrade ejaculation and/or in previously alkalinised urine. RESULT: Ejaculation was obtained in 10 cases (71.4%), either antegrade (7 cases), or retrograde (3 cases). The 4 failures corresponded to ejaculation failure in 3 cases and adverse effects of Gutron (hypertension) in 1 case. However, storage of spermatozoa could be performed in only 4 cases (40%), as pyospermia or severe necrospermia were observed in 6 cases. CONCLUSIONS: Midodrine hydrochloride gives good results in terms of ejaculation in spinal injury patients. However, the quality of semen collected is often poor due to the long interval since the initial trauma. Midodrine hydrochloride, ideally used after antibiotic treatment, can nevertheless constitute an alternative to other techniques.

Adolescent↗
PubMed1984

Pathology of spinal injuries.

Information about the neuropathology of spinal cord injury is derived from the personal study of 341 specimens; 225 of these were traumatic, including 123 with massive injuries. Thirty-one were associated with metastases, 38 were degenerative, and 6 were infectious. Included are 41 normal controls. The hyperacute human spinal injury study provides a reference base for animal experiments. A sound knowledge of the pathology of spinal injury is an essential prerequisite for the competent management of patients with these injuries. Because no lesions were found that would be amenable to surgical correction, the study supports the conservative approach, in keeping with the teaching and practice of Sir Ludwig Guttmann and Sir George Bedbrook. In most specimens traumatic necrosis was most severe in the central gray matter and adjoining posterior columns of the cord. Preserved continuity of a proportion of the lateral, anterior, and posterior white matter was usual. Space-taking subdural or extradural hemorrhages and hematomyelia were rare. In patients who survived for more than a few weeks, posttraumatic cysts resulted from removal of necrotic parenchyma by macrophages. Although in very severe injuries complete disruption of both bony and spinal cord tissues was observed, others with equally massive injuries showed some continuity of the spinal cord parenchyma. This somewhat unexpected observation is in accord with physiologic studies in which poly EMG and sensory-evoked potentials demonstrate continuity of long tracts across the lesion in patients who were otherwise clinically complete. Regeneration of nerve roots and to a lesser extent of central axons was evident in patients who survived for more than 5 or 6 months. Complications consisted of ascending or descending necrosis and enlarging cavities. There is clinical and physiologic evidence of remodeling of reflex systems in the spinal patient that manifests as a changing neurologic picture. It is possible that the use of a variety of techniques, such as electrical stimulation, would influence such plastic changes to the benefit of the patient. Little detailed anatomic information is available on this topic as a key area for future investigation.

Axons↗
PubMedDate not supplied

Rehabilitation following spinal injury: the nursing response.

Spinal cord injury is one of the most unexpected and devastating of events that typically affects young people, often males. Thus it stands in stark contrast to both multiple sclerosis and arthritis, the conditions considered in the previous two articles of this series. The differences do not end here as spinal injury is relatively stable once the initial phase has passed, whereas both multiple sclerosis and arthritis are progressive. However, despite this variation the literature suggests that rehabilitation in all three conditions raises similar concerns. This article focuses on these concerns and how nurses can respond to them.

Humans↗
PubMed1993

Hyponatraemia after acute spinal injury.

Of 134 patients admitted to the Midlands Centre for Spinal Injuries within 2 days of the spinal injury during 1991-1992, 25 developed hyponatraemia in the acute phase. Hyponatraemia was most common among patients with complete tetraplegia (45 per cent) and these patients tended to be younger as well as have more severe and prolonged hyponatraemia. Overhydration is a common cause of hyponatraemia in this group of patients and should be avoided.

Adolescent↗
PubMed2002

Spinal injury patterns resulting from car and motorcycle accidents.

STUDY DESIGN: Retrospective data analysis. OBJECTIVES: To determine spinal injury patterns and clinical outcomes in patients involved in automotive accidents. SUMMARY OF BACKGROUND DATA: The records of 22,858 patients collected prospectively as part of the Trauma Audit Research Network (UK) Database (1993-2000). METHODS: Analysis of the records of 1121 motorcyclists and 2718 car occupants involved in automotive trauma. RESULTS: Spinal injury occurred in 126 (11.2%) motorcyclists and 383 (14.1%) car occupants. Victims were predominantly young (mean ages: motorcycle 30.2 years, car 37.8 years) and male (motorcycle 88.9%, car 60.6%). The mean Injury Severity Scores were 18.8 and 15.1, respectively. Isolated spinal injuries occurred in 30 (23.8%) motorcyclists and 130 (33.9%) car occupants. The thoracic spine was most commonly injured in motorcyclists (54.8%), and the cervical spine was most commonly injured in car occupants (50.7%). Multiple regions were injured in 14 (10.3%) motorcyclists and 33 (8.5%) car occupants. Nine motorcyclists and 43 car occupants required spinal surgery. Median hospital stays were 11.5 days (range 0-235 days) and 10 days (range 0-252 days) in the motorcyclists and car occupants, respectively. There were 13 (10.3%) motorcycle- and 26 (6.8%) car-related deaths. CONCLUSION: Spinal injury patterns may reflect differing mechanisms of injury between the restrained car occupant and unrestrained motorcyclist. The motorcyclists were more severely injured, had more extremity trauma, a higher mortality rate, and a spinal injury pattern consistent with forced hyperflexion of the thoracic spine. The predominance of cervical injuries and higher incidence of neck and facial injuries in car occupants may reflect abdominothoracic seat belt restraint. The high frequency of multilevel injuries reaffirms the need for vigilance in patient assessment.

Accidents, Traffic↗
PubMed2006

A demographic profile of traumatic and non-traumatic spinal injury cases: a hospital-based study from India.

STUDY DESIGN AND SUBJECTS: Retrospective descriptive analysis of data of patients with spinal injuries admitted to a tertiary referral medical center from January 1, 2003 to December 31, 2004. OBJECTIVES: To identify the demographic profile of patients with spinal injuries admitted in this hospital. SETTING: Medical records department, Kasturba Hospital, Manipal, Karnataka, India. METHODS: A total of 207 patients with traumatic and non-traumatic spinal injuries were included in the study. The patient characteristics that were included were age groups, neurologic status, mode and neurological level of injury, management and recovery pattern. RESULTS: Ratio of men to women who sustained spinal injuries was 3.6:1. The maximum number of patients was in the age range of 20-39 years. The different levels of spine that sustained injuries were cervical spine (36.2%), thoracic spine (34.3%) and lumbar spine (29.5%). There were 118 patients with neurological deficit. Mechanisms of injury recorded were fall from height (58.9%), fall of weight (7.2%), motor vehicle accidents (21.3%) and non-traumatic causes (12.6%). Of these 207 spinal injury patients, 74.4% were managed conservatively, whereas 25.6% patients were managed surgically. OBSERVATION: This study gives a preliminary overview of the characteristics of patients with spinal injuries in this hospital.

Adolescent↗
PubMed2006

[Diagnosis and treatment of odontoid fracture combined with lower cervical spinal injury].

OBJECTIVE: To investigate the mechanism, clinical features and treatment of odontoid fracture combined with lower cervical spinal injury. METHODS: From January 1999 to December 2004, 57 cases of type II or shallow type III odontoid fractures were studied retrospectively. Six cases were found combined with lower cervical injury, the mean age was 54 years, and 4 of the 6 cases were complicated with cervical spondylarthrosis or ankylosing spondylitis. For the lower cervical injury, fracture-dislocation was found in 2 cases, the disruption of disc and ligament was found in 4 cases among which 2 cases were suffered from incomplete spinal cord injury; Both were caused by lower cervical spinal injury. All of the 6 cases were performed with surgery in odontoid fracture and lower cervical spinal injury simultaneously; Lower cervical spinal injuries were stabilized firstly in 2 cases, which responsible for neurological involvement; For the other 4 cases without neurological involvement, stabilization was performed in odontoid fracture firstly in 2 cases, due to inability to achieve reduction of odontoid fracture preoperatively, however, for the another 2 cases with anatomic reduction of the odontoid fracture preoperatively, lower cervical injuries were stabilized firstly. RESULTS: After an average follow-up of 10 months, all cases were obtained solid fusion both in odontoid fracture and lower cervical spinal injury, and without the complications associated with operation and prolonged bed rest. Two cases with neurological defect improved 1 scale in Frankel score. CONCLUSIONS: The incidence of odontoid fracture combined with lower cervical spinal injury is about 10.5% of the odontoid fracture, and it is vulnerable in the elderly patient with cervical spondylarthrosis. MRI should be used routinely for accurate diagnosis. Surgical stabilization is the choice of treatment due to facilitating early rehabilitation and reducing the complications. The surgical schedule is planned according to the fact of neurological involvement and the extent of stability between the odontoid fracture and lower cervical spinal injury.

Adolescent↗
PubMed1994

[Current status of spinal injuries in winter sports].

Parallel with a marked escalation in the number of injuries of the skull, shoulder girdle and upper extremities in recent years, the incidence of spinal injuries has also intensified. This is due to an increase in speed and deceleration traumas, such as are particular to collision accidents. Of all patients with winter sports injuries at the Department of Traumatology at Innsbruck University Hospital, 4.9% have a spinal trauma. A retrospective ten-year study was undertaken to analyze the surgically treated spinal injuries out of overall winter sports injuries. Between 1982 and 1992 862 spinal injuries were surgically treated, 10.9% (94) of which were suffered in winter sports accidents. Of these winter sports injuries, 81.7% (76) were due to skiing accidents. The age group 15 to 25 years made up the largest contingent at 39.8% (37). Most spinal traumas (47.3%), whether suffered in winter sports or not, were located in the thoracolumbar region or the lumbar part of the spine, followed by 38.7% at the cervical vertebrae. Serious snowboard accidents are especially predestined for injuries of the cervical vertebrae. The age group 51 to 60 years also shows a trend to injure the cervical vertebrae; degenerative changes present in this age span cause a high percentage of accompanying neurological injuries. More than half (52.7%) of all surgically treated spinal injuries showed some loss or impairment of neurological function at the time of admission; 17.2% of these cases showed symptoms of a complete transverse lesion of the cord. 36% of all serious spinal injuries are accompanied by secondary injuries (such as craniocerebral trauma, thoracic trauma and other fractures).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2003

Pain as a presenting feature of acute abdomen in spinal injuries.

The diagnosis of acute abdomen can be difficult in patients with spinal injuries. We reviewed all the 1039 case records of patients admitted with spinal injuries to the Queen Elizabeth National Spinal Injuries Unit, Glasgow over a 7-year-period and found 5 (0.48%) cases of acute abdomen that required surgical intervention and were not caused by original injury. Their presenting signs and symptoms were analysed. Pain was found to be an unreliable symptom in these patients.

Abdomen, Acute↗
PubMed2001

[Spinal injuries--diagnostic imaging].

Spinal trauma requires a prompt and detailed diagnosis for estimating the prognosis and installing proper therapy. Conventional radiograms are the first imaging modality in most cases. In the cervical and the lumbar spine, a CT has to be performed in patients with polytrauma and a higher risk of complications or with signs of instability. Especially for imaging the cervicocranium, multiplanar reformations in sagittal and coronal planes are necessary. For fractures of the thoracic spine, MR imaging is superior to CT because of the better detection of associated neurologic complications.

Adult↗
PubMed2004

Spinal injuries in rugby union, 1970-2003: lessons and responsibilities.

There was an increase in the frequency of rugby union spinal injuries worldwide during the 1970s and early 1980s. The United Kingdom and Australia have since had some success in reducing this increase in spinal injuries. These changes were the result of actions by rugby union authorities in response to recommendations by medical advisors; legal action by injured players has also played a part. The frequency of spinal injuries has not decreased in New Zealand (up to 2000) and South Africa (up to 1997). Rugby union authorities' responsibilities should include establishing and maintaining national and international spinal injury registers to forge closer working relationships with medical researchers. Such registers would provide up-to-date information for enhancing and developing preventive measures. There has been no specific publicly available record of the incidence of rugby union spinal injuries in Australia since 1996, so it is uncertain whether the safety measures introduced so far have had a lasting impact.

Athletic Injuries↗
PubMed1993

Late-onset papilledema following spinal injury. Case report.

Papilledema, is a known complication of various spinal pathologies. It has, however, been only infrequently reported following spinal injury, and may be overlooked in these cases. Presented herein is a 27 year old male who suffered thoracic and lumbar spinal injuries. Papilledema following mild increase in intracranial pressure (IICP) developed 3 weeks following trauma, and subsided within 8 weeks. The importance of routine repeat ophthalmoscopic examinations following spinal injury to detect changes characteristic of IICP is emphasized.

Acetazolamide↗
PubMed1996

Spinal injuries in the pediatric age group: a review of 82 cases of spinal cord and vertebral column injuries.

A review of 82 children with spinal cord and/or vertebral column injury treated in our department between 1968 and 1993 showed that 67% of the patients were boys and the average age was 11.4 years. The cause, vertebral level, and type of injury, and the severity of neurological injury varied with the age of the patient. The cause of pediatric injuries differed from that of adult injuries in that falls were the most common causative factor (56%) followed by vehicular accidents (23%). The most frequent level of spinal injury was in the cervical region (57%, 47 patients) followed by the lumbar region (16.5%, 13 patients). In our series, 18% of the patients had complete injury and the overall mortality rate was 3.6%. Eleven children (13%) had spinal cord injury without radiographic abnormality (SCIWORA), whereas 39 (47%) had evidence of neurological injury. Although the spinal injury patterns differed between children and adolescents, the outcome was found to be predominantly affected by the type of neurological injury (P < 0.05). Children with complete myelopathy uniformly remained with severe neurological dysfunction; children with incomplete myelopathy recovered nearly normal neurological function. Finally, the authors conclude that most spinal injuries can be successfully managed with nonoperative therapy. The literature is reviewed as to the treatment and outcome of pediatric spinal injuries.

Child↗
PubMed1983

[Pitfalls in the diagnosis of spinal injuries].

Injury to the spinal cord remains one of the great disasters which can disrupt any person's life. Although tremendous progress has been made concerning treatment and rehabilitation, our inability to change the irreversible nature of these injuries still underlines the vital importance of their prevention. Saving a patient from potential neurological damage depends upon the early recognition of unstable spinal injuries. Unfortunately, prompt diagnosis is not always the rule. We have identified the following seven diagnostic pitfalls in this regard, and again emphasize a few basic rules in dealing with them: (i) the 'sprained neck'; (ii) the normal radiograph; (iii) head injuries; (iv) multiple injuries; (v) the low cervical region; (vi) high dorsal lesions; and (vii) double spinal injuries.

Cervical Vertebrae↗
PubMed1982

Capacity for physical work and training after spinal injuries and strokes.

Patients with spinal injuries or strokes usually have an initially low capacity for physical work. The level of activity in daily living is also low. There is a further threat of inactivity with the risk of developing medical complications and social isolation. This process can be reversed by physical training and sport. Both patient groups can be trained and a training programme which improves endurance and muscle strength can be incorporated in primary rehabilitation of these patients without disturbing special treatment routines directed at function.

Adult↗