358 Surgical Management of Spinal Cord Injuries: An Overview of Controversies

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Jamal ◽  
A Sheeraz
Keyword(s):  
Spinal Cord ◽  
Closed Reduction ◽  
Spinal Cord Injuries ◽  
Financial Burden ◽  
Timing Of Surgery ◽  
Cervical Fractures ◽  
Consensus Statements ◽  
Randomised Controlled ◽  
The Uk

Abstract Aim Spinal Cord Injuries (SCI) are incredibly debilitating injuries associated with significant morbidity and financial burden, with an incidence of 12-16 per million population in the UK. There is currently no cure for SCI, with majority of interventions focusing on primary prevention of SCI or of further damage once SCI is sustained. We present an overview of the role of closed reduction, timing of surgery and role of steroids, and provide an algorithm for management of SCI. Method A search was carried out on PubMed, looking at notable reviews, consensus statements and trends in management of spinal cord injuries. This was cross-referenced with the NICE and BOAST guidelines for SCI. Results The efficacy of closed reduction in cervical fractures and necessity of pre-reduction MRI is still equivocal and remains a source of major debate amongst spinal surgeons. The timing of surgery remains controversial as studies have not consistently shown improved outcomes with early, aggressive surgery but there have been trends noted in the newer studies with some benefit of early surgery. The use of steroids in acute SCI has fallen out of favour with most guidelines not recommending them due to their equivocal benefit and unequivocal side-effect profile. Conclusions Prevention and pre-hospital management are crucial in the management of SCI, along with early spinal alignment restoration, decompression and stabilisation augmented by good long-term rehabilitation measures. There is a need for new randomised controlled trials assessing the role of closed reduction, need for pre-reduction MRI and timing of surgery in SCI.

scholarly journals Exoskeletons, Rehabilitation and Bodily Capacities

2021 ◽  
pp. 1357034X2110256
Author(s):  
Denisa Butnaru
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Crucial Role ◽  
Spinal Cord Injuries ◽  
Main Task ◽  
Cerebrovascular Accidents ◽  
Complex Processes ◽  
Cord Injury ◽  
Neurological Conditions

Motility impairments resulting from spinal cord injuries and cerebrovascular accidents are increasingly prevalent in society, leading to the growing development of rehabilitative robotic technologies, among them exoskeletons. This article outlines how bodies with neurological conditions such as spinal cord injury and stroke engage in processes of re-appropriation while using exoskeletons and some of the challenges they face. The main task of exoskeletons in rehabilitative environments is either to rehabilitate or ameliorate anatomic functions of impaired bodies. In these complex processes, they also play a crucial role in recasting specific corporeal phenomenologies. For the accomplishment of these forms of corporeal re-appropriation, the role of experts is crucial. This article explores how categories such as bodily resistance, techno-inter-corporeal co-production of bodies and machines, as well as body work mark the landscape of these contemporary forms of impaired corporeality. While defending corporeal extension rather than incorporation, I argue against the figure of the ‘cyborg’ and posit the idea of ‘residual subjectivity’.

scholarly journals Controversies in the Surgical Management of Spinal Cord Injuries

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Ahmed M. Raslan ◽  
Andrew N. Nemecek
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Surgical Management ◽  
Spinal Cord Injuries ◽  
Late Onset ◽  
Initial Step ◽  
Outcome Data ◽  
Cord Injury ◽  
The Usa

Traumatic spinal cord injury (SCI) affects over 200,000 people in the USA and is a major source of morbidity, mortality, and societal cost. Management of SCI includes several components. Acute management includes medical agents and surgical treatment that usually includes either all or a combination of reduction, decompression, and stabilization. Physical therapy and rehabilitation and late onset SCI problems also play a role. A review of the literature in regard to surgical management of SCI patients in the acute setting was undertaken. The controversy surrounding whether reduction is safe, or not, and whether prereduction magnetic resonance (MR) imaging to rule out traumatic disc herniation is essential is discussed. The controversial role of timing of surgical intervention and the choice of surgical approach in acute, incomplete, and acute traumatic SCI patients are reviewed. Surgical treatment is an essential tool in management of SCI patients and the controversy surrounding the timing of surgery remains unresolved. Presurgical reduction is considered safe and essential in the management of SCI with loss of alignment, at least as an initial step in the overall care of a SCI patient. Future prospective collection of outcome data that would suffice as evidence-based is recommended and necessary.

Emergency Cervical Splints — Their Value and Limitation

1985 ◽  
Vol 1 (S1) ◽  
pp. 197-198
Author(s):  
Andrew K. Marsden
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Spinal Cord Injuries ◽  
Motor Vehicle ◽  
Good Deal ◽  
First Aid ◽  
Front Seat ◽  
Comprehensive Management ◽  
General Impression

A good deal of controversy currently surrounds the role of collars and extrication devices in the on-site immobilization of suspected injuries to the cervical spine. The plethora of manufactured items readily available for this purpose reinforces the general impression that no one device is universally acceptable.In his book,Spinal Cord Injuries–Comprehensive Management and Research, Sir Ludwig Guttman stressed the importance of keeping all cervical movements to a minimum. Flexion, hyperextension and rotatory movements are particularly dangerous. The most difficult circumstances are those in which an unconscious front-seat occupant requires extrication from a damaged motor vehicle. Here the strict first-aid drill of gentle lifting by a six man team maintaining rigid traction in the line of the spine becomes impracticable and the rescuers have to resort to the use of aids.

scholarly journals Hydrogels and Cell Based Therapies in Spinal Cord Injury Regeneration

2015 ◽  
Vol 2015 ◽  
pp. 1-24 ◽  
Author(s):  
Rita C. Assunção-Silva ◽  
Eduardo D. Gomes ◽  
Nuno Sousa ◽  
Nuno A. Silva ◽  
António J. Salgado
Keyword(s):  
Spinal Cord ◽  
Stem Cells ◽  
Spinal Cord Injury ◽  
Cell Survival ◽  
Spinal Cord Injuries ◽  
Human Stem Cells ◽  
Related Disorder ◽  
Cord Injury ◽  
Cell Carriers

Spinal cord injury (SCI) is a central nervous system- (CNS-) related disorder for which there is yet no successful treatment. Within the past several years, cell-based therapies have been explored for SCI repair, including the use of pluripotent human stem cells, and a number of adult-derived stem and mature cells such as mesenchymal stem cells, olfactory ensheathing cells, and Schwann cells. Although promising, cell transplantation is often overturned by the poor cell survival in the treatment of spinal cord injuries. Alternatively, the therapeutic role of different cells has been used in tissue engineering approaches by engrafting cells with biomaterials. The latter have the advantages of physically mimicking the CNS tissue, while promoting a more permissive environment for cell survival, growth, and differentiation. The roles of both cell- and biomaterial-based therapies as single therapeutic approaches for SCI repair will be discussed in this review. Moreover, as the multifactorial inhibitory environment of a SCI suggests that combinatorial approaches would be more effective, the importance of using biomaterials as cell carriers will be herein highlighted, as well as the recent advances and achievements of these promising tools for neural tissue regeneration.

scholarly journals Role of necroptosis in Traumatic Brain and Spinal Cord Injuries

2021 ◽  
Author(s):  
Xinli Hu ◽  
Yu Xu ◽  
Haojie Zhang ◽  
Yao Li ◽  
Xiangyang Wang ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Brain And Spinal Cord

Role of Microglia and Astrocytes in Spinal Cord Injury Induced Neuropathic Pain

2021 ◽  
pp. 097275312110463
Author(s):  
Gurwattan S. Miranpuri ◽  
Parul Bali ◽  
Justyn Nguyen ◽  
Jason J Kim ◽  
Shweta Modgil ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Neuropathic Pain ◽  
Spinal Cord Injuries ◽  
Medical Condition ◽  
The United States ◽  
Current Treatment ◽  
Treatment Modalities ◽  
Cord Injury

Spinal cord injuries incite varying degrees of symptoms in patients, ranging from weakness and incoordination to paralysis. Common amongst spinal cord injury (SCI) patients, neuropathic pain (NP) is a debilitating medical condition. Unfortunately, there remain many clinical impediments in treating NP because there is a lack of understanding regarding the mechanisms behind SCI-induced NP (SCINP). Given that more than 450,000 people in the United States alone suffer from SCI, it is unsatisfactory that current treatments yield poor results in alleviating and treating NP. In this review, we briefly discussed the models of SCINP along with the mechanisms of NP progression. Further, current treatment modalities are herein explored for SCINP involving pharmacological interventions targeting glia cells and astrocytes. The studies presented in this review provide insight for new directions regarding SCINP alleviation. Given the severity and incapacitating effects of SCINP, it is imperative to study the pathways involved and find new therapeutic targets in coordination with stem cell research, and to develop a new gold-standard in SCINP treatment.

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