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PubMed1982

The demonstration and significance of neural compression after spinal injury.

Standard metrizamide myeLography and CT myelography can accurately and safely define neural compression after a spinal injury. A lateral C1-C2 spinal puncture and a radiolucent fracture board reduce movement of the spine, and by injecting metrizamide in an isotonic concentration and by limiting the amount of contrast above a block, the risk of seizure is minimized. This capability for directly determining neural compression has important implications for the treatment of spinal fractures, and the significance of persisting posttraumatic neural compression is discussed. We believe neural compression should be the primary indication for surgical decompression after spinal injury and that evaluation for it should now be a standard part of the examination of patients with spinal fractures with potential for neurological recovery.

Diagnosis, Differential↗
PubMed1978

Multiple level spinal injuries: importance of early recognition.

Patients with severe trauma may simultaneously sustain more than one level of spinal injury. Often, the second or third levels of injury are not recognized early enough to prevent clinically significant extension of the neurologic deficit, pain pattern, spinal instability, and/or deformity. A review of 710 spinal injury patients admitted to the Midwest Regional Spinal Cord Injury Care System yielded 4.5% multiple noncontiguous vertebral injuries. Thirty cases were studied in respect to location and type of primary and secondary injury. Of the secondary lesions, 40% occurred above and 60% below the primary lesion. In half of the patients, there was a mean of 52.6 days delay in diagnosis of the secondary lesion. Three major patterns of injury emerged from this analysis. Knowledge of these patterns and careful total spine radiography in patients with severe trauma may be a significant aid in early recognition of multiple level injuries and possible prevention of their complication.

Adolescent↗
PubMed1993

Ultrasound in the early diagnosis of heterotopic ossification in patients with spinal injuries.

Heterotopic ossification (HO) is a potentially disabling complication of spinal injuries and other chronic disorders. It is of unknown aetiology and currently there is no easy or convenient diagnostic method that will allow very early confirmation of the inflammatory changes that precede osteoid and, later, true bone formation. Clinical experience, however, indicates that early treatment with radiotherapy, antiinflammatory agents or diphosphonates is needed to control the progression. This study was undertaken to assess the role of ultrasound (US) in the very early diagnosis of HO in patients with spinal injuries. US was found to be very sensitive in detecting focal soft tissue abnormalities around joints and in the muscles of these patients. If combined with a Doppler study to exclude deep venous thrombosis (DVT), and infection or tumour could be excluded clinically, US was extremely accurate in predicting the presence or absence of early HO changes within hours of the clinical manifestation. In 2 patients it successfully predicted HO in the opposite leg before clinical signs were evident. This study also provided supportive evidence of the theory of microtrauma in the aetiology of HO. As ultrasound is portable, safe, cheap, reproducible and accurate, it is the method of choice in the early diagnosis of HO. It allows early treatment to prevent the formation of osteoid and subsequent bone formation.

Adult↗
PubMed2004

Snow sports related head and spinal injuries: an eight-year survey from the neurotrauma centre for the Snowy Mountains, Australia.

Neurotrauma from snow-sports related injuries is infrequently documented in the literature. In Australia no collective data has ever been published. The aim of this study is to document the injury pattern of snow sports related neurotrauma admissions to The Canberra Hospital, the regional trauma centre for the Snowy Mountains. A computerised hospital record search conducted between January 1994 and July 2002 revealed 25 head and 66 spinal injury admissions. The incidence of severe injuries requiring referral to tertiary trauma hospital was estimated to be 7.4 per 100,000 skier-days and for head and spinal injury 1.8 per 1,000,000 skier-days and 5.6 per 1,000,000 skier-days, respectively. Collision with a stationary object was disproportionately associated with head injury ( [Formula: see text] ) and falling forward with spinal injury ( [Formula: see text] ). Snowboarders tended to sustain cervical fractures more often than skiers ( [Formula: see text] ). The importance of helmet usage in buffering the impact of head-on collision and the proposition of having both feet fastened to a snowboard in leading to cervical injury were highlighted.

Adolescent↗
PubMed1993

Cardiac risk factors immediately following spinal injury.

Cardiac risk factors were evaluated in 48 persons (39 males, 9 females) with quadriplegia or paraplegia, resident in a specialized spinal injury hospital and seen 0.3 +/- 0.7 years after their spinal injury. The majority of the patients reported being extremely active physically prior to injury. Limited activity in the hospital involved the use of ergometers, pulleys, and weights; however, the majority of subjects expressed a wish for more exercise. Serum lipid profiles showed a relatively normal total cholesterol (mean 4.58 +/- 0.77 mmol/L), a very low high-density lipoprotein-cholesterol (0.91 +/- 0.27 mmol/L), a relatively normal low-density lipoprotein-cholesterol (2.86 +/- 0.68 mmol/L) and high triglycerides (1.89 +/- 0.88 mmol/L). Resting blood pressures were normal. The percentage of smokers (25%) was similar to the percentage of smokers in the general population, but many had quit smoking subsequent to hospitalization. Family histories and diet gave no evidence of increased cardiac risk. We conclude that individuals who sustain a spinal injury do not have a large inherent risk of cardiac events. In persons with paraplegia, cardiac problems develop mainly from the cumulative impact of reduced physical activity and a resulting adverse lipid profile. There may also be a reactive deterioration in other aspects of personal lifestyle, such as cigarette smoking after leaving the hospital. In high-level lesions, factors such as hypertension and a poor stroke volume with compensatory tachycardia may increase cardiac work rate during attempts at ambulation, further predisposing an individual to myocardial ischemia and cardiac arrest.

Adult↗
PubMed2005

Improvement in initial survival of spinal injuries: a 10-year audit.

A 10-year retrospective study of all spinal injuries presenting to the Leeds Teaching Hospitals between 1991 and 2001. The hospitals provide secondary care to a population of 750,000 and tertiary care to a population of 2-3 million. In total 1119 spinal injuries were studied. The overall survival rate was 89%. The commonest age group for presentation was 25-29 years with a secondary peak in the seventh decade, a mean overall of 43 years. 66% of injuries occurred in males. The commonest cause was a fall from a height (44%), with road traffic accidents (RTA) causing 43%. Pedestrians were most at risk within the road traffic group, making up 63% of cases. Isolated cervical spine injuries made up 37% of all cases. Cervical fractures were most associated with neurological injury (50%). Immediate survival has increased over the decade from 83% in 1991 to 93% in 2001. The probability of survival was significant at P = 0.006 and actual survival at P = 0.012 (Pearson correlation). The causal analysis has not been carried out but it is thought likely that improved quality of care is responsible.

Adolescent↗
PubMed2001

The role of computed tomography in cervical spinal injury due to diving.

We studied both the clinical features and computed tomography (CT) findings in 25 patients with a cervical spinal injury related to diving. In all patients the X-rays, including anteroposterior, lateral and open mouth views, were normal. The clinical features included headache, dizziness, without an alteration in the state of consciousness. In 5 patients, the CT spinal scan revealed cervical spinal injury unrecognised on X-ray. In 4 of them, the mechanism of the trauma was a direct injury to the head when it hit the bottom of the pool; in 1 patient, the mechanism was indirect injury transmitted from the stretched hands to the cervical spine. We conclude that the cervical spinal injury caused by diving should be evaluated selectively by CT spinal scan in patients with direct cervical injury, even if the clinical and roentgenographic results appear negative.

Adolescent↗
PubMed1961

Spinal injuries.

Explore the source record for details and available documents.

Humans↗
PubMed2003

Guanosine promotes myelination and functional recovery in chronic spinal injury.

Functional loss after spinal cord injury (SCI) is caused, in part, by demyelination of axons surviving the trauma. Administration of guanosine (8 mg/kg/day, i.p.) for 7 consecutive days, starting 5 weeks after moderate SCI in rats, improved locomotor function and spinal cord remyelination. Myelinogenesis was associated with an increase in the number of mature oligodendrocytes detected in guanosine-treated spinal cord sections in comparison with controls. These data indicate that guanosine-induced remyelination resulted, at least in part, from activation of endogenous oligodendrocyte lineage cells. These findings may have significant implications for chronic demyelinating diseases.

Animals↗
PubMed1986

Fatal cervical spinal injuries in road traffic accidents.

The present study analyses fatal road traffic accidents involving private cars and vans in Finland during the period 1972-1982, in which an injury to the cervical spine was the main cause of death. The material consists of 289 victims; this being 10.5 per cent of all the fatalities in this category of road traffic accidents. Front seat and rear seat passengers seem to have an equal risk of sustaining a fatal cervical spinal injury. However, front seat passengers have a significantly greater chance (P less than 0.001) of having fatal cervical spinal injuries than the drivers. Of the victims 21.1 per cent had worn safety belts but there was no statistical difference between those who did and those who did not wear safety belts. Increasing age seems to increase the risk of fatal cervical spinal injuries. Patients between 16 and 25 years of age had the lowest risk and patients over the age of 60 had the highest risk of sustaining a fatal cervical spinal injury (P less than 0.001). In 48.1 per cent of the cases, the victims were multiply injured and this is similar to other main causes of death in road traffic accidents. Wearers of safety belts had significantly (P less than 0.001) more multiple injuries. Of the patients who died of cervical injury, only 8.8 per cent survived transportation to hospital and 1.4 per cent survived longer than 24 hours. A direct blow was the most common mechanism of the cervical injury (47.1 per cent) and deceleration was found in 13.1 per cent of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Traffic↗
PubMed1981

Endorphins in experimental spinal injury: therapeutic effect of naloxone.

An experimental model of cat spinal injury was used to investigate the hypotheses that endorphins are involved in the pathophysiology of spinal cord injury and that the opiate antagonist naloxone, by blocking the effects of endorphins, may improve physiological and neurological recovery. Experimental trauma to the cervical spine caused a reduction in blood pressure and spinal cord blood flow (SCBF) associated with increased plasma levels of beta-endorphin-like immunoreactivity; both blood pressure and SCBF were significantly improved by naloxone treatment. Naloxone-treated animals also showed less prominent spinal cord abnormalities and significantly improved neurological recovery compared with saline controls. Moreover, both the pathological and clinical findings correlated significantly with the blood pressure changes following treatment. The data support a pathophysiological role for endorphins in experimental spinal cord injury and suggest that opiate antagonists might improve the treatment of spinal trauma in humans.

Animals↗
PubMed1994

[Rheumatoid blood factors in patients with complicated spinal injury].

Enzyme immunoassay (ELISA) was used to study the levels of serum rheumatoid factors (RF) of classes IgM and IgG in patients with spinal injuries and osteochondrosis. The findings show that at the late stages of the disease, the patients with spinal injury show 46% seropositiveness for IgG-RF and 40% for IgM-RF. Patients with fresh central nervous system (CNS) injuries were 12 and 14% seropositive, respectively. Patients with osteochondrosis exhibited 33% seropositiveness for IgG-RF. Determination of serum RF enables the authors to identify systemic body lesions at the late stages of spinal injuries as rheumatic disease. These data support the conclusion that RF determination is a reliable serological indicator of the severity of a patient's traumatic disease.

Biomarkers↗
PubMed2002

Sensitivity of sympathetically correlated spinal interneurons, renal sympathetic nerve activity, and arterial pressure to somatic and visceral stimuli after chronic spinal injury.

In the chronic stage of spinal cord injury in humans, both innocuous and noxious somatic and visceral stimuli can elicit severe autonomic dysreflexia characterized by potentially dangerous, sympathetically mediated, increases in arterial pressure. We hypothesized that a similar sympathetic hyperexcitability would be manifested in spinal sympathetic networks of chronically spinally transected rats. To test this hypothesis, we compared the responses of sympathetically correlated spinal interneurons and arterial pressure to both innocuous and noxious stimuli in acutely and chronically spinally transected rats. Experiments were conducted in anesthetized female rats, either within hours of T(3) spinal transection (rats with acute spinal transection) or one month after T(3) spinal transection (rats with chronic spinal transection). Sympathetically correlated spinal interneurons were identified by cross correlating their ongoing activity with simultaneously recorded renal sympathetic nerve activity. Cutaneous stimuli (either light brushing or noxious pinch) were delivered to a wide area of the ipsilateral side of the rat. Colorectal distension was used as a noxious visceral stimulus. The activity of sympathetically correlated interneurons was increased by stimulation of more of the body surface and decreased by stimulation of less of the body surface in rats with chronic spinal transection than in rats with acute spinal transection. Colorectal distension elicited greater increases in arterial pressure in chronically than acutely spinally-transected rats without exciting significantly more interneurons in those rats. These results suggest that spinal circuits undergo significant plastic changes in the chronic stage of spinal cord injury, and they provide a mechanism for the observation, in some human patients, that many stimuli, both noxious and non-noxious, applied caudal to the site of spinal injury increase sympathetic activity and arterial pressure.

Action Potentials↗
PubMed1984

The biomechanics of spinal injuries.

This manuscript is directed to review the epidemiology of spinal trauma, the anatomy of the vertebral column, spinal ligaments, muscles, motion of the spine and spinal cord. Because little information is available on the material properties of ligaments and the components of the vertebral column, this material is also included. A review of the experimental spinal cord injury models is given because of the concerted interest in this area today. Laboratory studies conducted in animals to develop typical spinal cord injury models and the corresponding alterations in perfusion and metabolic pathways, forces, and changes in the evoked potentials are discussed. Light and electron microscopy evaluations of the spinal cord are also treated. Clinical classifications of spinal injuries, pathology, and typical examples of upper cervical injuries, atlanto-axial disc locations and fractures, lower cervical spine injuries, injuries to thoracolumbar column with mathematical models, and typical force levels are given. The final section, investigation examples, provides a review of typical spinal injuries associated with sports injuries, motorcycle helmets, industrial helmets, and swimming pools investigated in our laboratories and by those of others. With lumped parameter mathematical model which predicts cervical compression, force, the various energies encountered in a one-dimensional impact is given. Typical examples of studies conducted on football helmets, motorcycle helmets, and industrial helmets are also included. Because of the importance of crash dummies used in the analysis of spinal injuries, a separate appendix is included, as well as an appendix reviewing motorcycle standards which are often dispersed throughout the literature. Considerable emphasis is placed upon actual experimental values of force and energy measured in the living animal and the most recent studies conducted in the fresh human cadaver to delineate the biomechanical mechanisms of spinal injury.

Accidents, Traffic↗
PubMed2003

[Changes in the approach and methods of acute surgical treatment in severe thoraco-lumbar spinal injuries].

The authors show the changes in the approach and methods concerning the acute surgical treatment of severe thoracolumbar spinal injuries. In the past 15 years, 878 acute surgical treatments have been done with ventral-, dorsal or combined method. The results are evaluated from the point of view of neurological function recovery, bony union, restoration of patients' comfort and complications. Authors discuss the changes of past 15 years regarding the basic ideas of the treatment of spinal injuries, the indications and methods of modern surgical techniques. The use of new surgical methods which are closely connected to the biomechanical characteristics of the injured spine are stressed, as well as the importance of the primary definitive ventral surgical treatment, in the case of a severe thoraco-lumbar spine injury.

Adult↗
PubMed1989

Sternal fractures associated with spinal injury.

Twenty-eight cases of sternal fractures and/or dislocations were reviewed for the presence of associated spinal injury. Patient records and radiographs were studied. Sixteen cases had inadequate radiographs to rule out spine fracture. Three cases had known direct injuries to the sternum. Of the remaining nine patients, eight had spine fractures. All of the spine fractures were consistent with a flexion injury mechanism. Three patients had spine fractures at the thoracic level and four at the lumbar level. One patient had lower cervical and thoracic injuries. In the patients with spine injury, the proximal manubrial fragment tended to displace posteriorly. Similarly, the manubrium would move posteriorly in manubriosternal dislocations. A case of spontaneous sternal fracture in a patient with osteoporosis and multiple thoracic compression fractures is described. One patient had open reduction of the manubriosternal joint. Three patients who were admitted for their sternal injuries had spine fractures which were not recognized during the hospitalization. There were no cases of mediastinal injury in the patients with combined sternal and spinal injuries. Flexion injury to the spine may cause buckling of the sternum. However, indirect sternal injury continues to be overlooked. Careful evaluation for spine injuries should be done on all patients with sternal fractures and vice versa.

Adult↗
PubMedDate not supplied

Spinal injury considerations in the competitive diver: a case report and review of the literature.

BACKGROUND CONTEXT: Despite significant literature associated with spinal injuries and recreational diving, few articles exist regarding competitive diving injuries, with no reports pertaining specifically to spinal injuries. As a result, a case report of a collegiate diver with C5-C6 ligamentous instability requiring operative stabilization is currently presented in addition to a review of the literature. PURPOSE: Present a case report of cervical C5-C6 ligamentous instability in a collegiate diver. STUDY DESIGN: Case report and literature review. METHODS: Not applicable. RESULTS: Not applicable. CONCLUSIONS: Diving injuries pertaining to competitive diving do occur but to a lesser extent than would be expected given the large forces the spine experiences. Training, experience and appropriate technique greatly minimize potential spinal hazards. Persistent complaints of neck pain after a competitive diving injury mandate aggressive evaluation and further workup.

Adult↗