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At least 19 recordsLinked to original sources
PubMed2006

Management of spinal injury.

Spinal injury often affects young adults and results in debilitating neurological status, which in turn places a significant burden on society. This review article describes the current practice and controversies surrounding the management of spinal injury. General principles of pre-hospital management, resuscitation, medical treatment, surgical intervention and future advancement are reviewed.

Emergency Medical Services↗
PubMedDate not supplied

Pediatric spinal injuries.

Spinal injuries in children present unique challenges. The anatomy of the growing child affects injury patterns and subsequent care. There are many challenges for the child and family, but current research is providing hope for the future.

Age Factors↗
PubMed2002

[Drug therapy of spastic disorder of urine outflow in patients with spinal injury and spinal cord injury].

A study was made of efficiency of medicamentous correction of a spastic disorder of outflow of urine from the bladder in 42 patients with dull trauma of the spinal column and marrow. The use in the above patients of cardura alpha 1-adrenoblocker permits restoring a spastic disorder of urine outflow in a 10-day period after the trauma sustained in 82 percent of patients. Shortening the time of a spastic disorder of urine outflow in patients with trauma of the spinal column and cord we allow the frequency of development of the infectious inflammatory process in organs of the urogenitary system to be substantially reduced.

Adolescent↗
PubMed1992

Spinal trauma. Pathophysiology and management of traumatic spinal injuries.

Spinal trauma can originate from internal or external sources. Injuries to the spinal cord can be classified as either concussive or compressive and concussive. The pathophysiologic events surrounding spinal cord injury include the primary injury (compression, concussion) and numerous secondary injury mechanisms (vascular, biochemical, electrolyte), which are mediated by excessive oxygen free radicles, neurotransmitter and electrolyte alterations in cell membrane permeability, excitotoxic amino acids, and various other biochemical factors that collectively result in reduced SCBF, ischemia, and eventual necrosis of the gray and white matter. Management of acute spinal cord injuries includes the use of a high-dose corticosteroid regimen within the initial 8 hours after trauma. Sodium prednisolone and methylprednisolone, at recommended doses, act as oxygen radical scavengers and are anti-inflammatory. Additional considerations are the stability of the vertebral column, other conditions associated with trauma (i.e., pneumothorax), and the presence or absence of spinal cord compression, which may warrant surgical therapy. Vertebral fractures or luxations can occur in any area of the spine but most commonly occur at the junction of mobile and immobile segments. Dorsal and dorsolateral surgical approaches are applicable to the lumbosacral and thoracolumbar spine and dorsal and ventral approaches to the cervical spine. Indications for surgical intervention include spinal cord compression and vertebral instability. Instability can be determined from the type of fracture, how many of the three compartments of the vertebrae are disrupted, and on occasion, by carefully positioned stress studies of fluoroscopy. Decompression (dorsal laminectomy, hemilaminectomy, or ventral cervical slot) is employed when compression of the spinal cord exists. The hemilaminectomy (unilateral or bilateral) causes less instability than dorsal laminectomy and therefore should be used when practical. The preferred approach for atlantoaxial subluxation is ventral, and the cross pinning, vertebral fusion technique is used for stabilization. Fracture luxations of C-2 are repaired with small plates on the ventral vertebral body. The thoracic and upper lumbar spine is stabilized with dorsal fixation techniques or combined dorsal spinal plate/vertebral body plate fixation. Several methods of fixation can be used with lower lumbar or lumbosacral fractures, including the modified segmental technique and the combined dorsal spinal plate/Kirschner-Ehmer technique.

Animals↗
PubMed2005

Approach and considerations regarding the patient with spinal injury.

Spinal trauma often results in a complex interaction of injuries to the musculoskeletal and nervous systems. This combination of biomechanical and neurological considerations provides a unique challenge to those dealing with the spinally injured patient. Proper assessment of the injuries sustained by the patient remains the initial, yet key, step in determining appropriate management. The aim of the physical examination is not only to characterize the nature of the injury to the vertebral column, but also to determine the extent of actual and potential damage to the neural elements. It is also concerned with detecting associated injuries of the brain, viscera, and limbs that can impact on management and outcome, particularly of any neurological deficit. Further information about the spinal column and spinal cord is derived from appropriate radiological assessment, which is evolving with the increasing sophistication of imaging modalities. In spinal injury, classification systems are particularly important as they simplify a diverse range of injury patterns into a useable and reproducible form that may be used to aid communication among clinicians, guide management for individual patients, and provide the basis for research consistency. The medical management involves consideration of the impact of spinal injury, in particular cord injury, on aspects including resuscitation and anticoagulation, as well as the role of steroids. The definitive management of the spinal column injury may be operative or nonoperative. Factors influencing this decision are biomechanical (stabilization of the unstable spine and reduction of deformity) and neurological (improvement in deficit and decompression of neural elements). This article considers these issues and aims to present a balanced and useful algorithm for clinicians to use when faced with spinal injury.

Emergency Medical Services↗
PubMed1980

The role of the sympathetic nervous system in pressor responses induced by spinal injury.

Spinal cord injury consistently evokes a transient 3- to 4-minute rise is systemic pressure, followed by prolonged hypotension. Because the role of the sympathetic nervous system in these blood pressure changes is not clear, the pressure responses were studied using systematic ablation of the peripheral sympathetic nervous system. In total, 24 cats were subjected to bilateral thoracic sympathectomy, adrenalectomy, splanchnicectomy, combinations of the preceding, sham operation, or no treatment. Either 3 or 24 hours after the ablations, the blood pressure responses were evoked by 400 gm-cm contusions of the thoracic cord. Although neither thoracic sympathectomy nor adrenalectomy alone abolished the hypertensive phase, the combination of the two procedures did. This suggests that both the thoracic sympathetic ganglia and the adrenal glands participate in the pressor response. Thoracic sympathectomy affected primarily the early part, whereas adrenalectomy diminished the later part of the hypertensive response. This correlates with the function of the former being neurally and the latter being humorally mediated. None of the sympathetic lesions consistently affected the hypotensive phase. Spinal contusion injury produces widespread sympathetic activation, mediating the hypertensive changes.

Adrenal Medulla↗
PubMed1995

Defining assessment parameters in dual injuries: spinal cord injury and traumatic brain injury.

Assessment parameters for muscle testing in the individual with a spinal cord injury (SCI) have been clearly defined by the American Spinal Injury Association (ASIA). However, the ASIA standard requires the individual's participation in reporting sensory information and he/she must be able to perform specific tasks to complete the examination. In an individual with a dual injury, a SCI and a traumatic brain injury (TBI), neurological assessment can be impeded by the individual's inability to participate in the exam. Assessment needs to incorporate both cognitive and physical parameters that will appropriately assess both injuries. This article reviews the assessment parameters for both spinal cord injury and traumatic brain injury and provides assessment guidelines for bedside evaluation of functional ability. In addition, a review of the biomechanics of injury will provide a model for understanding dual injury.

Biomechanical Phenomena↗
PubMed1999

Association of head trauma with cervical spine injury, spinal cord injury, or both.

BACKGROUND: Links between cervical spine and/or spinal cord injuries and head trauma have not been reported in detail. METHODS: 188 patients with cervical spine and/or spinal cord injury were divided into two groups, i.e., with upper cervical and mid-lower cervical injury, and compared for head injury. RESULTS: Associated head trauma was investigated in 188 patients with cervical spine and/or spinal cord injuries; 35% had moderate or severe injuries. Brain damage was more frequently observed in patients with upper cervical injury than in those with mid to lower cervical injury. Those patients with upper cervical injury appeared to have an elevated risk of suffering skull base fractures, traumatic subarachnoid hemorrhage, and contusional hemotoma. CONCLUSIONS: Approximately one third of patients with cervical spine and/or spinal cord injuries had moderate or severe head injuries. Brain damage was more frequently associated with upper cervical injury. Those patients with upper cervical injury are at greater risk of suffering from skull base fractures and severe intracranial hematomas than those with mid to lower cervical injury.

Adolescent↗
PubMed2002

Neurogenic bladder model for spinal cord injury: spinal cord microdialysis and chronic urodynamics.

We describe an animal model to study neurotransmitter changes in parallel with urodynamic testing following Spinal Cord Injury (SCI). Urodynamic access was achieved using a subcutaneously placed 7 French dual lumen portacatheter. Spinal cord injury was induced by weight drop technique onto exposed dura at T8. The L6-S1 detrusor nuclei were localized stereotactically and microdialysis probe placement was confirmed through histologic methods. Chronic urodynamics revealed detrusor hyperreflexia (DH) 14 days following SCI. In vivo microdialysis of spinal cord amino acids was performed using CMA 11 (240 uM) probes in halothane-anesthetized rats at baseline and intervals of 20-30 min following spinal cord injury. Significant increases in the excitatory amino acid glutamate, and the inhibitory amino acids, glycine and taurine, were seen following spinal cord injury. Amino acid levels peaked at approximately 40 min following contusion injury with glycine demonstrating the highest levels of all amino acids measured. This neurogenic rat model provides a useful means of examining the effects of spinal cord injury on bladder function. By utilizing spinal cord microdialysis, one could intervene at the level of the detrusor nuclei to modulate bladder function.

Animals↗
PubMed1982

Spinal cord injury, spinal fracture, and spinal stenosis in ankylosing spondylitis.

The authors report a retrospective review of 105 patients with ankylosing spondylitis (AS) diagnosed over a 6-year period in Tucson, Arizona. In the series, there were 13 patients with spinal fractures and eight with severe spinal cord injury. Two patients with central cord contusion had no demonstrable cervical spine fracture. Injury was often trivial and dislocation at fractures sites was minimal, demonstrating the extreme fragility of these patients. Spinal stenosis, which has not previously been associated with AS, was documented in three cases. Pseudarthrosis, a destructive vertebral lesion that does not require surgical decompression or fusion, was found in four patients; this entity is believed to originate as a pathological or traumatic fracture. Atlanto-axial subluxation and basilar invagination associated with spinal ankylosis occurred in one patient. The study emphasizes the value of computerized tomography scanning of the spine for diagnosis, and halo-vest application as a nonoperative treatment for cervical immobilization. Early diagnosis and appropriate therapy to decompress, reduce, and immobilize unstable spinal lesions may result in reduction of the 29% mortality rate and 45% permanent neurological morbidity rate observed after spinal fracture in this series of AS patients. Because of the high operative complication rate observed, nonsurgical immobilization is the recommended treatment unless spinal dislocation or bone fragment displacement has occurred at the fracture site.

Adult↗
PubMedDate not supplied

Non-contiguous spinal injury in cervical spinal trauma: evaluation with cervical spine MRI.

OBJECTIVE: We wished to evaluate the incidence of non-contiguous spinal injury in the cervicothoracic junction (CTJ) or the upper thoracic spines on cervical spinal MR images in the patients with cervical spinal injuries. MATERIALS AND METHODS: Seventy-five cervical spine MR imagings for acute cervical spinal injury were retrospectively reviewed (58 men and 17 women, mean age: 35.3, range: 18 81 years). They were divided into three groups based on the mechanism of injury; axial compression, hyperflexion or hyperextension injury, according to the findings on the MR and CT images. On cervical spine MR images, we evaluated the presence of non-contiguous spinal injury in the CTJ or upper thoracic spine with regard to the presence of marrow contusion or fracture, ligament injury, traumatic disc herniation and spinal cord injury. RESULTS: Twenty-one cases (28%) showed CTJ or upper thoracic spinal injuries (C7-T5) on cervical spinal MR images that were separated from the cervical spinal injuries. Seven of 21 cases revealed overt fractures in the CTJs or upper thoracic spines. Ligament injury in these regions was found in three cases. Traumatic disc herniation and spinal cord injury in these regions were shown in one and two cases, respectively. The incidence of the non-contiguous spinal injuries in CTJ or upper thoracic spines was higher in the axial compression injury group (35.3%) than in the hyperflexion injury group (26.9%) or the hyperextension (25%) injury group. However, there was no statistical significance (p > 0.05). CONCLUSION: Cervical spinal MR revealed non-contiguous CTJ or upper thoracic spinal injuries in 28% of the patients with cervical spinal injury. The mechanism of cervical spinal injury did not significantly affect the incidence of the noncontiguous CTJ or upper thoracic spinal injury.

Acute Disease↗
PubMed1997

[Acute surgical diseases in spinal injuries with spinal cord lesions].

Authors analyse the group of 22 operated patients admitted to the Spinal Centre of the Traumatological Hospital Brno for instable spinal fracture with the transversal lesion of the spinal cord, in whom the acutely affected abdomen and acute surgical disease manifested. The anamnestic and clinic examination of the abdomen is not reliable in patients with the transversal lesion of spinal cord for valid laws of the spinal cord. Authors evaluate the contribution of new diagnostic imaging techniques and endoscopic methods to determinate the early indication for surgical treatment.

Abdomen↗
PubMed1983

Thermoregulatory set point in patients with spinal cord injuries (spinal man).

The thermoregulatory set point in man can be estimated by the aid of quantifying thermal alliesthesial responses. Behavioural and autonomous thermoregulation in a group of nine patients with spinal cord transection was compared against a control group of six non-disabled under various room-climate conditions. Deviation of core temperature from thermoregulatory set point was estimated using a behavioural indicator (thermal alliesthesial responses) at different intervals of the exposure time. General thermal comfort sensation was rated on a subjective thermal comfort scale. The group with spinal cord transections showed, as expected, a state of partial poikilothermia. Mean skin temperature was approximately the same in both groups, but skin temperature distribution was different in the spinal cord transection when compared against the control group. The results of thermal alliesthesial responses indicated that core temperature for those with spinal cord transections were closer to their thermoregulatory set points than in the control group. It has been concluded that under conditions beyond thermal neutrality the spinal man may possess, some time after the injury, a thermoregulatory set point which varies directly with ambient thermal conditions. This phenomenon is viewed as an adaptive thermoregulatory process following spinal cord injury.

Adaptation, Physiological↗
PubMed1989

A new approach to catastrophic injury: spinal cord injury patients.

Catastrophic injuries and illnesses create great financial strains on patients who require lifetime care. Families, health care providers and insurers recognise that individual patient care needs require a closer look at the prudent allocation of health care benefit dollars. Blue Cross Blue Shield of Michigan has initiated an approach to this problem called 'case management'. Two ventilator dependent quadriplegics were discharged home utilising the case management concept. This system provides many advantages for patients. However, the health care team needs to be aware of the drawbacks of the system.

Adult↗