Early Decompression and Short Transport Time After Traumatic Spinal Cord Injury are Associated with Higher American Spinal Injury Association Impairment Scale Conversion

Spine ◽  
2022 ◽  
Vol 47 (1) ◽  
pp. 59-66
Author(s):  
Robert C. Sterner ◽  
Nathaniel P. Brooks
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Injury ◽  
Traumatic Spinal Cord Injury ◽  
American Spinal Injury Association ◽  
Transport Time ◽  
Cord Injury

scholarly journals Características clínicas, complicaciones secundarias y apoyos en personas con lesión medular traumática en Asturias

2020 ◽  
Vol 19 (4) ◽  
pp. 322-348
Author(s):  
Andrea Rodríguez Alonso ◽  
Enrique Oltra Rodríguez
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Injury ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Traumatic Spinal Cord Injury ◽  
American Spinal Injury Association ◽  
Secondary Complications ◽  
Cross Sectional ◽  
Cord Injury

Introducción: La lesión medular traumática es un acontecimiento sobrevenido y frecuentemente devastador debido a la pérdida funcional, a las complicaciones secundarias y a la inexistencia de tratamiento curativo. Se plantea como un reto personal, sanitario y social. El objetivo del estudio es describir las características epidemiológicas, clínicas y los apoyos utilizados de las personas con lesión medular traumática del Principado de Asturias.Materiales y método: Estudio observacional, descriptivo y transversal. La población estuvo conformada por personas con lesión medular traumática ingresadas por cualquier causa en el Hospital Universitario Central de Asturias del 1 de enero de 2005 al 31 de enero de 2015.Resultados: El número de casos fue 92. Un 76,9% eran hombres. La edad media fue 48,5 años y la edad media cuando se produjo la lesión 40,2 años. Las causas más frecuentes fueron los accidentes: de tráfico, laborales y fortuitos. El tipo de lesión más frecuente: según afectación de miembros, la paraplejia con un 38,5%; según la extensión, la lesión incompleta con un 52,6%; según el nivel neurológico, la lesión dorsal con un 45,4% y según la escala de clasificación de la American Spinal Injury Association (ASIA), la lesión ASIA A con un 50,7%. Como complicaciones secundarias más frecuentes: el 68,7% presenta vejiga neurógena, el 60,2% intestino neurógeno, el 46,5 úlceras por presión, 46,4% espasticidad y el 30,1% dolor neuropático. Conclusiones: Existe una alta prevalencia de complicaciones secundarias en la lesión medular, siendo necesario aunar esfuerzos en la prevención y tratamiento de las mismas. Background and objective: Traumatic spinal cord injury is a supervening and often devastating event due to functional loss, secondary complications and lack of curative treatment. It is posed as a personal, health and social challenge. The objective of the study is to describe the epidemiological, clinical and support characteristics of people with traumatic spinal cord injury in the Principality of Asturias.Materials and method: Observational, descriptive and cross-sectional study. The population comprised people with traumatic spinal cord injury admitted for any reason at the Central University Hospital of Asturias from January 1, 2005 to January 31, 2015.Results: The number of cases was 92. 76.9% were men. The average age was 48.5 years old and the average age when the injury occurred was 40.2 years old. The most frequent causes were accidents: traffic, labor and fortuitous. The most frequent type of injury: according to limb involvement, paraplegia with 38.5%; according to the extension, the incomplete lesion with 52.6%; according to the neurological level, the dorsal lesion with 45.4% and according to the classification scale of the American Spinal Injury Association (ASIA), the ASIA A lesion with 50.7%. As most frequent secondary complications: 68.7% have neurogenic bladder, 60.2% neurogenic bowel, 46.5% pressure ulcers, 46.4% spasticity and 30.1% neuropathic pain.Conclusions: There is a high prevalence of secondary complications in spinal cord injury, being necessary to join efforts in the prevention and treatment of them.

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

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.

Long-Term Follow-up of Patients with Spinal Cord Injury

2005 ◽  
Vol 19 (4) ◽  
pp. 332-337 ◽  
Author(s):  
Figen Yilmaz ◽  
Fusun Sahin ◽  
Semra Aktug ◽  
Banu Kuran ◽  
Adem Yilmaz
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Injury ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
American Spinal Injury Association ◽  
Cord Injury ◽  
Long Term Follow Up

Objective. The aim of this study was to evaluate the motor, sensory, and functional recovery in patients with spinal cord injury (SCI). Methods. Forty-one patients with SCI participated in this study. Twenty patients were evaluated after discharge. Each patient was evaluated by the American Spinal Injury Association (ASIA) impairment scale and the Functional Independence Measure (FIM) at admission, before discharge, and at least at 6 months after discharge. Friedman, Dunn, and Mann-Whitney U tests were used for statistical analysis. Results. There were 17 male and 3 female patients. Seven patients had complete SCI, and 13 patients had incomplete SCI. The evaluation of motor, sensory, and FIM scores at admission showed significant improvement in all of the patients during the follow-up period (P < 0.0001). Five incompletely injured cases improved with regard to ASIA staging. Motor and FIM scores significantly increased at follow-up for converted and unconverted patients. All parameters increased at follow-up in patients who were complete and incomplete. Motor scores significantly increased at discharge and at follow-up. FIM scores also increased significantly at follow-up in incomplete patients. Conclusion. Motor, sensory, and FIM scores increased in patients with SCI after a follow-up period of 18 months. Improvement to a higher ASIA stage could be accomplished by 25% of the patients. Although both complete and incomplete patients recovered significantly at the follow-up period, only incompletely injured cases could convert to a higher ASIA stage.

Failure of Mean Arterial Pressure Goals to Improve Outcomes Following Penetrating Spinal Cord Injury

Neurosurgery ◽  
2016 ◽  
Vol 79 (5) ◽  
pp. 708-714 ◽  
Author(s):  
William J. Readdy ◽  
Rajiv Saigal ◽  
William D. Whetstone ◽  
Anthony N. Mefford ◽  
Adam R. Ferguson ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Patient Population ◽  
Spinal Injury ◽  
Neurological Recovery ◽  
American Spinal Injury Association ◽  
Neurological Improvement ◽  
Cord Injury

Abstract BACKGROUND: Increased spinal cord perfusion and blood pressure goals have been recommended for spinal cord injury (SCI). Penetrating SCI is associated with poor prognosis, but there is a paucity of literature examining the role of vasopressor administration for the maintenance of mean arterial pressure (MAP) goals in this patient population. OBJECTIVE: To elucidate this topic and to determine the efficacy of vasopressor administration in penetrating SCI by examining a case series of consecutive penetrating SCIs. METHODS: We reviewed consecutive patients with complete penetrating SCI who met inclusion and exclusion criteria, including the administration of vasopressors to maintain MAP goals. We identified 14 patients with complete penetrating SCIs with an admission American Spinal Injury Association grade of A from 2005 to 2011. The neurological recovery, complications, interventions, and vasopressor administration strategies were reviewed and compared with those of a cohort with complete blunt SCI. RESULTS: In our patient population, only 1 patient with penetrating SCI (7.1%) experienced neurological recovery, as determined by improvement in the American Spinal Injury Association grade, despite the administration of vasopressors for supraphysiological MAP goals for an average of 101.07 ± 34.96 hours. Furthermore, 71.43% of patients with penetrating SCI treated with vasopressors experienced associated cardiogenic complications. CONCLUSION: Given the decreased likelihood of neurological improvement in penetrating injuries, it may be important to re-examine intervention strategies in this population. Specifically, the use of vasopressors, in particular dopamine, with their associated complications is more likely to cause complications than to result in neurological improvement. Our experience shows that patients with acute penetrating SCI are unlikely to recover, despite aggressive cardiopulmonary management.

scholarly journals Selenium-Binding Protein 1 (SELENBP1) as Biomarker for Adverse Clinical Outcome After Traumatic Spinal Cord Injury

2021 ◽  
Vol 15 ◽  
Author(s):  
Julian Seelig ◽  
Raban Arved Heller ◽  
Patrick Haubruck ◽  
Qian Sun ◽  
Jochen Georg Klingenberg ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Injury ◽  
Cell Damage ◽  
Cell Activity ◽  
Mechanical Trauma ◽  
Specific Cell ◽  
Traumatic Spinal Cord Injury ◽  
Cord Injury ◽  
Sensory Functions

Graphical AbstractThe pathophysiology of traumatic spinal cord injury (TSCI) can be divided into two major phases. (A) The mechanical trauma is followed within minutes by a secondary phase consisting of local complex and intertwined acute responses, intercellular signaling and cell activity regulating pathways. Inflammatory processes, oxidative stress and hypoxia, leading to cell damage and death, and specific cell contents are released into the circulation (B). The motor and sensory deficits upon TSCI are assessed by using the American Spinal Injury Association (ASIA) impairment scale (AIS), ranging from AIS A as a complete absence of any motor and sensory functions under the lesion site, to AIS E with complete preservation of motor and sensory functions. (C) The concentrations of serum SELENBP1 were elevated in patients classified as AIS A as compared to less severely affected patients classified as AIS B, C or D. A cut-off was deduced [(SELENBP1) &gt; 30.2 μg/L], reliably predicting whether a patient belongs to the group showing neurological recovery (G1) or not (G0) within 3 months after the trauma. The figure was created by using https://biorender.com.

scholarly journals Spinal cord injury as a trigger to develop periodic leg movements during sleep: an evolutionary perspective

2012 ◽  
Vol 70 (11) ◽  
pp. 880-884 ◽  
Author(s):  
Susana Cristina Lerosa Telles ◽  
Rosana S. Cardoso Alves ◽  
Gerson Chadi
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Injury ◽  
Pattern Generator ◽  
Periodic Limb Movement ◽  
American Spinal Injury Association ◽  
Evolutionary Perspective ◽  
Periodic Leg Movements ◽  
Cord Injury ◽  
Leg Movements

The primary trigger to periodic limb movement (PLM) during sleep is still unknown. Its association with the restless legs syndrome (RLS) is established in humans and was reported in spinal cord injury (SCI) patients classified by the American Spinal Injury Association (ASIA) as A. Its pathogenesis has not been completely unraveled, though recent advances might enhance our knowledge about those malfunctions. PLM association with central pattern generator (CPG) is one of the possible pathologic mechanisms involved. This article reviewed the advances in PLM and RLS genetics, the evolution of CPG functioning, and the neurotransmitters involved in CPG, PLM and RLS. We have proposed that SCI might be a trigger to develop PLM.

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