Traumatic spinal injury and spinal cord injury: point for active physiological conservative management as compared to surgical management

The management of the traumatic spinal cord injury remains controversial. Guttmann demonstrated that with simultaneous attention to all medical and non-medical effects of the spinal cord injury, a significant number of patients recovered motor and sensory functions to ambulate and the majority were pain-free following conservative management. Active physiological conservative management of the spinal injury requires simultaneous scrupulous care of the injured spine together with; the multisystem neurogenic effects of the spinal cord injury on the respiratory, cardiovascular, urinary, gastrointestinal, dermatological, sexual and reproductive functions; the management of the associated psychological effects of paralysis from the early hours or days of injury as well as; the physical rehabilitation and modification of the environment. To date, there is no evidence to suggest that the surgical decompression and/or stabilisation of the neurologically impaired spinal cord injury patient is advantageous. This article considers the debates and evidence of surgical management including the effects of timing of the surgical decompression. Also addressed are the factors influencing decisions on management, prognostic indicators of recovery and natural history of complete and incomplete cord injuries. Traumatic biomechanical instability of the spine, physiological instability of the spinal cord, traumatic spinal canal encroachment and traumatic cord compression are also discussed. Early mobilisation, indications for surgery at the RJAH and economic considerations of spinal cord injuries are presented. The ultimate goals of the active physiological conservative management are to ensure maximum neurological recovery and independence, a pain-free and flexible spine, safe and convenient functioning of the various systems of the body with minimal inconvenience to patients and the prevention of complications.

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Faculty Opinions recommendation of Medical and surgical management after spinal cord injury: vasopressor usage, early surgerys, and complications.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718105982.793555971 ◽

2019 ◽

Author(s):

Gregory Hawryluk

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Surgical Management ◽

Cord Injury

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Rehabilitation of the canine patient following spinal cord injury: a practical guide

Companion Animal ◽

10.12968/coan.2020.0060 ◽

2021 ◽

Vol 26 (1) ◽

pp. 1-6

Author(s):

Cheryl Corral

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Spinal Injury ◽

Neurological Deficits ◽

Practical Guide ◽

Cord Injury ◽

Physical Therapies

This article forms part of a series exploring the rehabilitation of the canine shoulder, elbow, back, hip and stifle following injury or disease. Discussed here are different rehabilitation techniques used to address neurological deficits, pain and weakness following spinal injury, including physical therapies, electrotherapies and acupuncture.

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Influence of severity and level of injury on the occurrence of complications during the subacute and chronic stage of traumatic spinal cord injury: a systematic review

Journal of Neurosurgery Spine ◽

10.3171/2021.7.spine21537 ◽

2021 ◽

pp. 1-21

Author(s):

Charlotte Y. Adegeest ◽

Jort A. N. van Gent ◽

Janneke M. Stolwijk-Swüste ◽

Marcel W. M. Post ◽

William P. Vandertop ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Spinal Injury ◽

Chronic Phase ◽

Autonomic Dysreflexia ◽

Traumatic Spinal Cord Injury ◽

Chronic Stage ◽

Increased Risk ◽

Cord Injury ◽

Meta Analyses

OBJECTIVE Secondary health conditions (SHCs) are long-term complications that frequently occur due to traumatic spinal cord injury (tSCI) and can negatively affect quality of life in this patient population. This study provides an overview of the associations between the severity and level of injury and the occurrence of SHCs in tSCI. METHODS A systematic search was conducted in PubMed and Embase that retrieved 44 studies on the influence of severity and/or level of injury on the occurrence of SHCs in the subacute and chronic phase of tSCI (from 3 months after trauma). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. RESULTS In the majority of studies, patients with motor-complete tSCI (American Spinal Injury Association [ASIA] Impairment Scale [AIS] grade A or B) had a significantly increased occurrence of SHCs in comparison to patients with motor-incomplete tSCI (AIS grade C or D), such as respiratory and urogenital complications, musculoskeletal disorders, pressure ulcers, and autonomic dysreflexia. In contrast, an increased prevalence of pain was seen in patients with motor-incomplete injuries. In addition, higher rates of pulmonary infections, spasticity, and autonomic dysreflexia were observed in patients with tetraplegia. Patients with paraplegia more commonly suffered from hypertension, venous thromboembolism, and pain. CONCLUSIONS This review suggests that patients with a motor-complete tSCI have an increased risk of developing SHCs during the subacute and chronic stage of tSCI in comparison with patients with motor-incomplete tSCI. Future studies should examine whether systematic monitoring during rehabilitation and the subacute and chronic phase in patients with motor-complete tSCI could lead to early detection and potential prevention of SHCs in this population.

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Olfactory ensheathing cell transplantation for chronic spinal cord injury: A long-term follow-up study

Journal of Neurorestoratology ◽

10.26599/jnr.2021.9040008 ◽

2021 ◽

Vol 9 (2) ◽

pp. 94-105

Author(s):

Naifeng Kuang ◽

Xiaoyu Wang ◽

Yuexia Chen ◽

Guifeng Liu ◽

Fan’e Kong ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Autonomic Function ◽

Spinal Injury ◽

International Standards ◽

Olfactory Ensheathing Cell ◽

Cord Injury ◽

Long Term Follow Up

Spinal cord injury is a serious disabling condition. Transplantation of olfactory ensheathing cells (OECs) is one of the most promising treatments for spinal cord injury (SCI). Thirty-nine patients with chronic SCI received OEC transplantation and completed long-term follow-up, with a minimum follow-up of 7 years. We assessed sensorimotor function with the American Spinal Injury Association (ASIA) Impairment Scale (AIS) and autonomic nervous function by the International Standards to document remaining Autonomic Function after Spinal Cord Injury (ISAFSCI), and sympathetic skin responses (SSR). The scores of each group were significantly higher after OECs transplantation than before treatment. SSR latencies were shorter and response amplitudes increased after treatment. Long-term follow-up showed further improvement only in motor function and autonomic function compared with 3 months postoperatively. No complications occurred in any patient during long-term follow-up. The results indicate that the transplantation of OECs in spinal cord restored function without serious side effects.

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SOME ASPECTS OF PEDIATRIC SPINAL CORD INJURY

Hirurgiâ pozvonočnika ◽

10.14531/ss2005.4.15-19 ◽

2005 ◽

pp. 015-019

Author(s):

Igor Ivanovich Larkin ◽

Valery Ivanovich Larkin

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Spinal Cord Injuries ◽

Spinal Injury ◽

Radiological Diagnostics ◽

Cord Injury ◽

Pediatric Spinal Cord Injury ◽

Mri Changes

Objective. To analyse the possibility of diagnostics improvement in children with spinal cord injuries. Material and Methods. The observations of 147 cases of various spinal cord injuries in children at the age of 11 months to 15 years have been analyzed. Causes of trauma, age peculiarities of spinal injury manifestations, and difficulties of clinical and radiological diagnostics are discussed. Results. Most cases of spinal cord injury in children could be revealed and adequately managed at a prehospital stage. It should be noted that the spine lesion and MRI changes do not always accompany spinal cord injury in children. This observation must be taken into account while making diagnosis. Conclusion. Electromyography is an important examination confirming spinal cord injury without radiographic abnormalities (SCIWORA syndrome) in children.

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Management of Sacral Pressure Sore by Clinically Isolated Superior Gluteal Artery Perforator-based Fasciocutaneus Flap in Patients with Spinal Cord Injury

Indian Journal of Physical Medicine and Rehabilitation ◽

10.5005/ijopmr-27-1-14 ◽

2016 ◽

Vol 27 (1) ◽

pp. 14-18

Author(s):

S P Das ◽

Mamtamanjari Sahu ◽

Pramod Kumar Parida

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Constant Pressure ◽

Spinal Injury ◽

Wound Dehiscence ◽

Pressure Sore ◽

Superior Gluteal Artery ◽

Doppler Probe ◽

Cord Injury ◽

Artery Perforator

Abstract Prolong confinement to bed in spinal injury patients imparts constant pressure on bony prominences resulting impairment of blood flow to local tissue. Constant pressure of 2 hours or more produces irreversible changes leading to tissue necrosis and development of pressure sore. Sacrum encounters highest pressure in supine position and is the commonest site of pressure sore in spinal cord injury patients followed by trochanter and heel. Objective of the study Observation on management of sacral pressure sore by superior gluteal arterial perforatorbased flap using anatomical land marks in the absence of facility of Doppler probe for isolation of superior gluteal arterial perforators. Materials and methods Thirteen patients of spinal cord injury presented with sacral pressure sore were managed surgically using superior gluteal artery perforator-based flap coverage. The location of the artery was identifi ed using anatomical land marks. In 10 patients the flap was heeled uneventfully, one had signifi cant complication with wound dehiscence. Conclusions Management of sacral pressure sore by superior gluteal arterial perforator-based flap using anatomical land marks is a simple and reliable procedure. The learning curve is not that stiff. Sophisticated instruments are not required for this procedure.

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Traumatic Spinal Cord Injury

10.2310/neuro.2402 ◽

2018 ◽

Author(s):

Ryan Martin ◽

Lara Zimmermann ◽

Kee D. Kim ◽

Marike Zwienenberg ◽

Kiarash Shahlaie

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Surgical Management ◽

Burst Fracture ◽

Compression Fracture ◽

The United States ◽

Traumatic Spinal Cord Injury ◽

Early Management ◽

Pressure Therapy ◽

Cord Injury

Traumatic spinal cord injury currently affects approximately 285,000 persons in the United States and carries with it significant morbidity and cost. Early management focuses on adequate ventilation and hemodynamic resuscitation of the patient and limiting motion of the spine to prevent a second injury. Medical management targets maintenance of adequate blood flow to the spinal cord, whereas surgical management focuses on decompression, realignment, and stabilization of the vertebral column. In this chapter, we discuss the approach to the patient with traumatic spinal cord injury, injury types, and medical and surgical management. This review contains 9 figures, 4 tables and 30 references Key Words: American Spinal Injury Association score, burst fracture, Chance fracture, compression fracture, hangman, mean arterial pressure therapy, odontoid fracture, spinal cord injury, traction

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Traumatic Spinal Cord Injury

10.2310/7ccsp.2402 ◽

2018 ◽

Author(s):

Ryan Martin ◽

Lara Zimmermann ◽

Kee D. Kim ◽

Marike Zwienenberg ◽

Kiarash Shahlaie

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Surgical Management ◽

Burst Fracture ◽

Compression Fracture ◽

The United States ◽

Traumatic Spinal Cord Injury ◽

Early Management ◽

Pressure Therapy ◽

Cord Injury

Traumatic spinal cord injury currently affects approximately 285,000 persons in the United States and carries with it significant morbidity and cost. Early management focuses on adequate ventilation and hemodynamic resuscitation of the patient and limiting motion of the spine to prevent a second injury. Medical management targets maintenance of adequate blood flow to the spinal cord, whereas surgical management focuses on decompression, realignment, and stabilization of the vertebral column. In this chapter, we discuss the approach to the patient with traumatic spinal cord injury, injury types, and medical and surgical management. This review contains 9 figures, 4 tables and 30 references Key Words: American Spinal Injury Association score, burst fracture, Chance fracture, compression fracture, hangman, mean arterial pressure therapy, odontoid fracture, spinal cord injury, traction

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