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PubMed2002

Failure to administer methylprednisolone for acute traumatic spinal cord injury-a prospective audit of 100 patients from a regional spinal injuries unit.

OVERVIEW: The National Acute Spinal Cord Injury Studies (NASCIS II and III) and the Cochrane review advocate the administration of high dose methylprednisolone following acute traumatic spinal cord injury. OBJECTIVE: To determine the actual use and correct implementation of the NASCIS protocols in patients referred to a regional spinal injuries unit. DESIGN: Observational study on the timing and correct dosage of methylprednisolone. The admission Frankel grade, American Spinal Injury Association (ASIA) neurological classification were recorded prospectively. SUBJECTS: The 100 consecutive patients with complete or incomplete spinal cord injuries (Frankel grade A-D) were studied over a 2 years period. MAIN OUTCOME MEASURE: Correct administration of methylprednisolone according to the NASCIS protocols. RESULTS: During the study period only 25% of the patients admitted to our spinal injuries unit received methylprednisolone at the referring hospital according to the NASCIS protocols. An additional 10 patients were given methylprednisolone incorrectly. CONCLUSION: Evidence based medicine is not being practiced in the management of patients with acute spinal cord injury.

Acute Disease↗
PubMed1996

Pathology of spinal cord injuries due to fracture-dislocations of the thoracic and lumbar spine.

The pathology of intervertebral disc injuries, hyper-extension injuries and spinal cord injuries due to fracture-dislocations of the cervical spine has been reported previously. Between 1957 and 1987, autopsy was performed on 4 patients with fracture-dislocation of the thoracic spine and on one patient with that of the lumbar spine. This paper presents the results of a clinicopathologic study conducted on two patients with a fracture-dislocation of the thoracic spine and on one patient with that pathology of the lumbar spine. The methods employed in the present study are the same as those that were described in my previous report on the pathology of cervical inter-vertebral disc injuries.

Adult↗
PubMed2002

Spinal cord injury medicine. 4. Optimal participation in life after spinal cord injury: physical, psychosocial, and economic reintegration into the environment.

UNLABELLED: This learner-directed module on spinal cord injury (SCI) presents a variety of perspectives of the process of personal and environmental adaptation for reintegration. Adaptation is unique to each person and does not predictably follow stages. Models used for understanding the process include biopsychosocial, ICIDH-2 (International Classification of Functioning, Disability and Health), and sector divisions of the environment. Home modification requires home (intermediate environment) evaluation and sociospatial behavioral mapping for planning and appropriation of remodeling in proportion to functional need and use. Options for access to the natural environment include specialized wheelchairs, climbing rigging, kayaks, and sail boats. Sports participation with adaptations is expanding and includes a larger variety of organizations and leagues. Economic needs are effectively anticipated with development of a life care plan. Procreative options to overcome infertility after SCI include vibratory stimulation for ejaculation, intravaginal insemination, intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection. Approaches to requests for withdrawal of life-sustaining care include depression screening, pain evaluation, and assistance in accomplishment of person centered goals. Overall, community reintegration after SCI is continually improving because of better acceptance, accessibility, and technology for building adaptations. OVERALL ARTICLE OBJECTIVES: (a) To review models and theories of medical intervention and disablement and (b) to demonstrate their application in rehabilitation practice by designing unique treatment plans that meet patient person-centered goals.

Adaptation, Physiological↗
PubMed1993

High-dose steroid therapy offers improvement in spinal cord injuries.

A spinal-cord injury can alter every aspect of a victim's life. Despite continued improvements in mortality associated with a spinal-cord injury, until recently little progress had been made in improving neurologic function. This paper reviews the development of steroid therapy for spinal cord injuries, the mechanisms of action, and the nursing care associated with its use.

Adult↗
PubMed1998

Tactile allodynia, but not thermal hyperalgesia, of the hindlimbs is blocked by spinal transection in rats with nerve injury.

Spinal nerve ligation produces signs of neuropathic pain in rats. Different neuronal pathways may underlie the abnormal sensory responses to thermal and tactile stimuli. Here, the possibility that local circuitry in the spinal cord and/or spinal-supraspinal loops might be involved in tactile allodynia and thermal hyperalgesia of the hindpaws was investigated by transecting the spinal cord of sham-operated or L5/L6 nerve ligated rats. Spinal transection completely abolished tactile allodynia in ligated rats. Thermal nocifensive responses were present after transection in ligated and sham-operated rats. Thermal hyperalgesia of the hindpaws was not evident in spinal transected, ligated rats. Tail-withdrawal responses to tactile probing were very robust after spinal transection in both groups, demonstrating loss of descending inhibition. These observations suggest that thermal hyperalgesia of the paw seen after nerve injury involves both spinal and supraspinal circuits, while tactile allodynia depends on a supraspinal loop. This difference may reflect afferent inputs associated with different fiber types.

Animals↗
PubMed1993

Effect of U-50488h, a selective opioid kappa receptor agonist, on vascular injury after spinal cord trauma.

U-50488H, a selective opioid kappa receptor agonist has been shown to be a neuroprotective agent in animal models of spinal cord injury. The mechanism of action of U-50488H is not known. Methylprednisolone, the only neuroprotective drug proven in patients with acute spinal cord injury may prevent the secondary injury after an initial trauma. Secondary vascular injury develops after experimental spinal cord trauma. In this study we examined the effects of U-50488H on post-traumatic vascular injury based on the measurement of vascular permeability, edema and neutrophil infiltration in a rat spinal cord injury model. Vascular permeability was assessed by vascular extravasation of fluorescein isothiocyanate conjugated dextran (FITC-D), a macromolecular tracer. Tissue edema was determined by percentage water content and neutrophil infiltration by myeloperoxidase (MPO) activity, a marker enzyme for neutrophils. U-50488H at doses of 5, 10, 20 and 40 mg/kg i.p. administered twice (0.5 h before and 0.5 h after trauma) reduced vascular permeability in a dose-dependent manner. More frequent dosing (10 mg/kg, 0.5 h before and 0.5, 2, 8 and 22 h after injury) reduced vascular permeability 24 h after injury. U-50488H also reduced edema formation but did not affect neutrophil infiltration. Results from this study raise the possibility that the neuroprotective effect of U-50488H involves a secondary vascular event.

3,4-Dichloro-N-methyl-N-(2-(1-pyrrolidinyl)-cycloh↗
PubMed2005

Magnesium sulfate treatment decreases caspase-3 activity after experimental spinal cord injury in rats.

BACKGROUND: Apoptosis has increasingly been considered as an important factor in secondary injury after spinal cord injury (SCI). Manifestation of apoptotic cell death process involves activation of the caspase-3 apoptotic cascade. The aim of the study was to demonstrate the effect of magnesium sulfate on caspase-3 activity and to compare its effectiveness with methylprednisolone after acute SCI. METHODS: The rats were randomly and blindly allocated into 5 groups of 8 rats each. Spinal cord contusion injury was produced by the weight drop method. The control group consisted of non-injured rats. In the trauma group, no treatment was given, whereas 1 mL saline, 600 mg/kg magnesium sulfate, and 30 mg/kg methylprednisolone sodium succinate (MPSS) were administered in the vehicle and both treatment groups immediately after injury. Twenty-four hours after trauma, spinal cord samples were obtained, and tissue caspase-3 activity levels were examined. A 1-way analysis of variance and the post hoc test were used for statistical analysis. RESULTS: The results showed that caspase-3 activity increased to statistically significantly higher levels in spinal cord after contusion injury than in the control group. Caspase-3 enzyme activity levels were significantly reduced in animals treated either with magnesium sulfate or MPSS. CONCLUSIONS: We have shown that magnesium sulfate decreases caspase-3 activity in rat spinal cord subjected to contusion injury. Magnesium sulfate may have potential therapeutic benefits by reducing apoptotic tissue damage after SCI.

Animals↗
PubMed1978

Secondary spinal lesions in spinal cord injury patients.

On hospital admission, 6 spinal cord injured patients were noted to have second noncontiguous levels of spinal injury that were previously unrecognized. These secondary levels of spinal injury were diagnosed as a result of routine admission total spine radiographic examinations. Two cases are described in detail, one with the secondary spinal lesion above and the other below the primary spinal cord injury. Careful total spine radiographic studies are recommended to prevent complications, in the event that such lesions are initially unrecognized.

Adolescent↗
PubMed1997

Apoptosis and delayed degeneration after spinal cord injury in rats and monkeys.

Apoptosis is a morphologically defined form of programmed cell death seen in a variety of circumstances, including immune cell selection, carcinogenesis and development. Apoptosis has very recently been seen after ischemic or traumatic injury to the central nervous system (CNS), suggesting that active cell death as well as passive necrosis may mediate damage after CNS injury. After spinal cord injury (SCI) in the rat, typical post-traumatic necrosis occurred, but in addition, apoptotic cells were found from 6 hours to 3 weeks after injury, especially in the spinal white matter. Apoptotic cells were positive for oligodendrocyte markers. After SCI in monkeys, apoptotic cells were found within remote degenerating fiber tracts. Both secondary degeneration at the site of SCI and the chronic demyelination of tracts away from the injury appear to be due in part to apoptosis. As cytokines have been shown to mediate oligodendrocyte death in vitro, it seems likely that chronic demyelination after CNS injury shares features with chronic degenerative disorders like multiple sclerosis.

Animals↗
PubMed1995

Arm crank exercise with static leg FNS in persons with spinal cord injury.

Persons with spinal cord injury experience considerable difficulty, during aerobic exercise, in achieving even moderate levels of oxygen uptake. Therefore, the effect of static functional neuromuscular stimulation (FNS) on this parameter during arm crank exercise (ACE) was investigated. Eight subjects with spinal cord injury, lesion levels range C6-T12, performed ACE at 60% and 80% of VO2peak, both with and without concurrent FNS of the lower limbs. ACE was performed with no FNS, with FNS at 40 milliamperes (mA), and with FNS at 80 mA. Significant differences in oxygen uptake were found between ACE without FNS and ACE with FNS-80 mA at 60% VO2peak (10% increase, 12.5 ml.kg-1.min-1 to 13.7 ml.kg-1.min-1, P < 0.05), and between ACE without FNS and ACE with FNS-80 mA at 80% VO2peak (16%, increase, 14.8 ml.kg-1.min-1 to 17.2 ml.kg-1.min-1, P < 0.01). A 10% difference between ACE without FNS and ACE with FNS-40 mA, did not reach significance. These data indicate that, in this population of subjects with spinal cord injury, (a) FNS can increase submaximal ACE oxygen uptake, and (b) that such increases are enhanced both at higher levels of FNS and of work load. Implications for wellness are discussed.

Adult↗
PubMed2001

Urodynamic and rectomanometric findings in patients with spinal cord injury.

Patients with spinal cord lesion suffer from complex disorders of bladder and anorectal function. We assessed the value of urodynamics and anorectal manometry as prognostic and diagnostic tools in these patients and evaluated the usefulness of these techniques for the differentiation between complete and incomplete spinal cord lesions. Thirty patients with suprasacral spinal cord injury (six women, 24 men; mean age, 31 years) underwent anorectal manometry and urodynamics within the first 40 days after injury. The findings were compared to the results of a clinical neurologic evaluation. Fifteen patients were classified as complete lesions on their clinical signs, three of these lesions were incomplete according to urodynamic testing and five were incomplete according to visceral sensory testing by anorectal manometry. Despite significant differences in maximum bladder capacity (589 versus 465 mL), maximum detrusor pressure (18 versus 31 cm H2O) was not significantly different between patients with complete and patients with incomplete spinal cord injury. Anorectal manometry did not reveal any significant differences in resting pressure, abdominal pressure, and maximal rectum volume between these groups. Urodynamics and anorectal manometry may be superior to neurologic assessment of completeness of spinal cord lesions. Urodynamics and anorectal manometry were not helpful in the prediction of onset or severity of detrusor hyperreflexia. Thus, we do not regard anorectal manometry as a standard diagnostic tool in spinal cord injury patients.

Adolescent↗
PubMed1975

Spinal cord injury in children.

The spinal injured child has speical needs owing to the processes of physical, mental and social growth. Goals of physical treatment programs include prevention of: genitourinary complications; contractures; pressure sores; long bone fractures, hip subluxation and dislocation; spinal deformity. Nonoperative treatment of spinal deformity employing external support should be initiated when the potential for spinal deformity exists. External support delays the development of spinal deformity, improves sitting balance and allows free upper extremity use. The overall treatment programs must consider altered body proportions, immaturity of strength and coordination. Case examples of children with spinal injury are presented above to illustrate specific problems stemming from immaturity of physical, cognitive, and social development. Spinal surgery can be a conservative measure in the growing child when there is radiologic evidence of progressive spinal deformity. Posterior spinal fusion with Harrington instrumentation and external support permits immediate return to vertical activity.

Adolescent↗
PubMed1997

[Traumatic ascending ischemic injury of the spinal cord].

We report five cases that the paraplegic level showed ascending from the segment of spinal injury upward to the higher level. In T10-11 fracture-dislocation, the paraplegic level ascended gradually to C2-3 in case 1 within 10 days and death due to breathing paralysis. In case 2, the paraplegic level ascended to cervical cord with loss of strength in both arms within 14 days. The remaining 3 cases were Ti2(in 2 cases) and L3(1 case) fracture. Their paraplegic level ascended to T8(2 cases) and T9(1 case). There were lower motor neuron paralysis in all cases. Observation on spinal cord specimen of case 1 showed thrombosis of dorsal vessels at T9-10 segment and multiple thrombosis were found in anterior spinal vessels, central spinal vessels and intramedullar small vessels upward to C3 and downward to S1 segments. The whole cord underwent ischemic necrosis.

Adult↗
PubMed1988

Residual motor functions in spinal cord injury.

After acute spinal cord injury, only 10% of the patients experience significant functional recovery. The remaining 90% reveal numerous varieties of spinal cord dysfunctions with different degrees of incomplete and unsatisfactory recovery of functional usage. In such cases of partial recovery of spinal cord functions, a certain degree of restitution of functions can be achieved. By studying these patients and their neurocontrol, we can learn that there are minimal requirements for the restitution of brain influence on segmental mechanisms and that different degrees of control can exist and contribute to the control of steps. These cases exemplify that upper motor neuron paresis is not only a weaker control owing to the loss of a certain percentage of functional fibers: it is an alternative in neurocontrol resulting from suprasegmental and segmental mechanisms within residual structures and their functional performance. On the basis of our observations we conclude that in addition to the model of the "transected spinal cord injury" and the model of the partially injured spinal cord, there is a third model with "discomplete lesion," indicating that it is necessary to revise the conventional concept of "released segmental functions" in patients with transected spinal cord lesion.

Humans↗