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At least 19 recordsLinked to original sources
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↗
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↗
PubMed1991

The interobserver reliability of the revised American Spinal Injury Association standards for neurological classification of spinal injury patients.

To test the interobserver reliability of clinicians using the American Spinal Injury Association's 1989 revised "Standards for Neurological Classification of Spinal Injury Patients," two quizzes were given to 15 house officers and physician faculty members of a department of Physical Medicine and Rehabilitation. The first quiz consisted of five spinal cord injury cases of varying degrees of complexity. The participants were asked to classify each case with respect to sensory level, motor level, zone of injury and Frankel classification by using the original standards. Two months later, after a brief explanation of the significant changes in the revised standards, the same group was given five slightly different cases to classify. With the use of the 1989 revision of the standards, the percent correct improved for Frankel grade (65-81%), motor level (59-85%), sensory level (71-93%) and zone of injury (31-89%). Many of the same type of errors were repeated in both quizzes, i.e., T-12 and L-1 sensory level distinction and the classification of thoracic motor levels. We conclude that the interobserver reliability for the revised ASIA standards, although improved, continues to be less than optimal. We recommend that changes clarifying sensory levels near the inguinal ligament and motor level classification with very incomplete injuries be made in the standards. In addition, training methods should be developed to improve the interobserver reliability of the standards when they are used by clinicians and researchers.

Humans↗
PubMed1992

Pediatric spinal injury: review of 174 hospital admissions.

Injury to the spinal column and spinal cord occurs relatively infrequently in the pediatric population. A review of 174 pediatric patients is presented, representing 5.4% of all patients admitted with spinal injury. Spinal cord injury was present in 45% of patients. A distinct injury profile, explained by anatomical and biomechanical features, distinguishes the young patient with an immature spine from older adolescents with a more mature, adult-like spine. The younger patients, while less likely to have spinal injury, had a higher incidence of neurological injury, in addition to a higher frequency of both spinal cord injury without radiological abnormality and upper cervical cord injury. In addition, younger patients with spinal cord injury and no radiological abnormality were more likely to have complete or severe cord injury. Prognosis was determined by the severity of spinal cord injury. Patients with complete cord injuries showed little improvement, while patients with incomplete injuries generally fared much better, with 74% showing significant improvement and 59% experiencing a complete recovery of neurological functions. There were six deaths, but none was attributed solely to spinal injury. The authors conclude that outcome is quite good after pediatric spinal cord injury that does not produce a physiologically complete cord deficit.

Adolescent↗
PubMed1977

Paraplegia from traumatic spinal injury.

Acute spinal injury with paresis or paralysis is an increasing problem in modern communities. The corrdinated efforts of many are necessary for its management. The expertise developed by various disciplines through work with nonparaplegic patients should be coupled with the specific expertise of those responsible for total care. Generally, operative techniques have only a limited application, whereas basic medical and nursing techniques give good results.

Contracture↗
PubMed1975

Spinal injuries in children.

Spinal injuries with neurologic sequelae are a rare but catastrophic injury. Many of these injuries might be preventable through proper parent and child education, particularly in water sports and vehicles accidents. A significant number of neurologic injuries are incomplete at the time of injury and proper rescue and initial care may make the difference between life as a quadriplegic and life as a normal individual. Because of the complexity of the management of the child with spinal injuries and their relative rarity, the definitive care is best undertaken at hospitals which specialize in the care of spinal injuries. Progressive deformity of the spine, a problem unique to childhood and adolescent paralysis, is often preventable with prolonged immobilization and protection of the spine. Progressive deformities which interfere with function or result in neurologic deterioration require an aggressive surgical approach.

Accidents, Traffic↗
PubMed1989

[Spinal injury in children].

We reported five cases of children with spinal injuries. Spinal injuries are rare in children, and most common from the occiput to C3 in children younger than 8 years. In our cases, two younger children had upper cervical lesions and two older children had lower lesions. These differences result from anatomical characteristics, such as special histological architecture of the growth zones in younger children. One patient had a delayed onset paraplegia without radiographic abnormality. This phenomenon seems to be one of the characteristics of the spinal injuries in children. Because of this, all children with head or neck injuries should be fully investigated. A nine-month-old child who suffered from a fracture of the odontoid process with atlantoaxial dislocation was treated by immobilization only, and the result was good. Generally, fracture of the odontoid process in young children can be treated by proper immobilization. One patient with fracture dislocation of the cervical spine died as a result of cord injury. So immediate surgical decompression is mandatory for patients with evidence of cord compression.

Adolescent↗
PubMed2026

Treatment of spinal injury muscle spasticity by spinal subpial AAV9-GAD65/VGAT delivery: An efficacy and safety study in rat, pig, and NHP.

The loss in segmental inhibitory GABAergic tone plays the key role in the development of spinal injury-induced muscle spasticity. We use a subpial segment-targeted delivery of adeno-associated virus vector(s) expressing GAD65 (glutamic acid decarboxylase-65) and VGAT (vesicular GABA transporter) transgenes in rats with spinal transection-induced spasticity. In treated animals, a significant suppression in spasticity was seen at 5-8 weeks after treatment. Naive rats, pigs, and non-human primates (NHPs) injected with human equivalent dose of treatment vectors and surviving for 3 weeks to 4.5 years showed normal motor function and pinch-evoked response. A significant increase in the number of VGLUT2 terminals co-expressing GAD65 and VGAT protein in vector-injected segment was seen. This corresponded with the presence of transgene-specific rat Gad2 or human GAD2 and rat Slc32a1 or human SLC32A1 mRNA signal. No spinal toxicity was noted in NHPs at 4.5 years post vector delivery. Analysis of peripheral organs (liver, spleen, and skeletal muscle) showed minimal or no detectable transgenes in pigs and NHPs. These data demonstrate that a single-time-point spinal-segment-targeted subpial delivery of GAD65/VGAT transgenes is effective in suppressing spinal injury-induced spasticity and has a favorable long-term safety profile as defined by normal neurological function and histopathology in naive pigs and NHPs.

Animals↗
PubMed1992

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↗
PubMed1978

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↗
PubMed1992

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↗
PubMed1989

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↗
PubMed1992

[Complications in surgical management of spinal injuries].

Operative treatment of spinal injuries requires an accurate surgical technique and biochemical know-how to avoid complications due to mistakes in device handling, operative technique, and indication. Device failures are caused by loosening of locking clamps or fracture of Schanz screws, followed by loss of angle stability and early loss of reduction. Maldisplacement of pedicle screws may involve irritation of neurovascular structures or loss of correction as well as insufficient transpedicular bone reduction and bone grafting. In burst fractures with destruction of the vertebral body and loose canal fragments, the posterior approach is less efficient than a combined procedure.

Biomechanical Phenomena↗
PubMed1991

The value of magnetic resonance imaging (MRI) in the follow-up management of spinal injury.

Twenty-seven patients with spinal injury have been studied with follow-up Magnetic Resonance Imaging (MRI). MRI has helped (a) to determine the extent of cord injury; (b) to detect continuing compression to the spinal cord; (c) to discover unexpected pathologies and most importantly (d) to detect the development of post traumatic syrinx. MRI was most valuable in patients with post-traumatic syrinxes to evaluate any changes in the size, and, in those who had a shunting procedure, to assess the efficacy of the procedure. MRI also aided in planning complicated one stage operations by giving a 'complete' picture of the injury inflicted to the vertebrae, soft tissue structures and the spinal cord. As well as advantages in clinical audit it makes financial sense. It provides more information than CT myelography and is non-invasive. When compared to the cost of neurological deterioration it is much more cost effective to follow-up spinal injury patients with MRI. It is the authors' contention that after the acute phase all patients with spinal injury should have at least one MRI.

Adolescent↗
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↗