scholarly journals Epidemiology of War-Related Spinal Cord Injury Among Combatants: A Systematic Review

2018 ◽  
Vol 9 (5) ◽  
pp. 545-558 ◽  
Author(s):  
Julio C. Furlan ◽  
Sivakumar Gulasingam ◽  
B. Catharine Craven
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Spinal Injury ◽  
White Men ◽  
Lumbar Level ◽  
Cord Injury ◽  
Distinct Features ◽  
The Military ◽  
First Time

Study Design: Systematic review. Objectives: War-related spinal cord injuries (SCIs) are commonly more severe and complex than traumatic SCIs among civilians. This systematic review, for the first time, synthesized and critically appraised the literature on the epidemiology of war-related SCIs. This review aimed to identify distinct features from the civilian SCIs that can have an impact on the management of military and civilian SCIs. Methods: Medline, EMBASE, and PsycINFO databases were searched for articles on epidemiology of war-related SCI among combatants, published from 1946 to December 20, 2017. This review included only original publications on epidemiological aspects of SCIs that occur during an act of war. The STROBE statement was used to examine the quality of the publications. Results: The literature search identified 1594 publications, of which 25 articles fulfilled the inclusion and exclusion criteria. The studies were classified into the following topics: 17 articles reported demographics, level and severity of SCI, mechanism of injury and/or associated bodily injuries; 5 articles reported the incidence of war-related SCI; and 6 articles reported the frequency of SCI among other war-related bodily injuries. Overall, military personnel with war-related SCI were typically young, white men, with predominantly thoracic or lumbar level, complete (American Spinal Injury Association [ASIA] Impairment Scale A) SCI due to gunshot or explosion and often associated with other bodily injuries. Marines appear to be at a greater risk of war-related SCI than the military personal in the Army, Navy, and Air Force. Conclusions: The war-related SCIs among soldiers are distinct from the traumatic SCI in the general population. The majority of the current literature is based on the American experiences in most recent wars.

scholarly journals THE RATE OF ACUTE SPINAL CORD INJURY IN TASHKENT CITY BETWEEN 2005-2012 YEARS

2014 ◽  
Vol 7 (2) ◽  
Author(s):  
Rukhulla Zabikhullaevich Khikmatullaev ◽  
Alisher Iskandarovich Iskandarov ◽  
Dildora Zabikhullaevna Khakimova
Keyword(s):  
Spinal Cord ◽  
Traffic Accidents ◽  
Spinal Cord Injuries ◽  
Road Traffic ◽  
Lumbar Level ◽  
Thoracic Level ◽  
Medical Institutions ◽  
Cord Injury ◽  
Working Age ◽  
First Time

Objective: to analyze main clinical-statistical indices of spine and spinal cord injuries (SCI) and system of organization of medical aid to the victims. We conducted a cohort retrospective study of materials of medical institutions of Tashkent city. Medical records of patients and records of forensic examinations were analyzed. 242 cases of spinal cord injuries were studied. Over the last 10 years in Tashkent the frequency of SCI have been tend to increase, males and working-age people are dominated. In 60.9% of cases the injury was associated, in 36.2% - isolated, and in 2.9% - combined. Fallings from height and road traffic accidents were the main reasons for getting SCI. Lesions at cervical level registered in 45% of cases, thoracic level - 27.3%, at lumbar level - 27.7%, respectively. According to ASIA/IMSOP, full injuries were noted in 40.1% of cases, incomplete injures were in 59.9%. Overall mortality from SCI was 68.6%. Thus, for the first time this study allowed to get in detail the clinical and statistical indicators of SCI in the region.

scholarly journals SOME ASPECTS OF PEDIATRIC SPINAL CORD INJURY

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.

scholarly journals Nonsteroidal Anti-Inflammatory Drugs and Their Neuroprotective Role After an Acute Spinal Cord Injury: A Systematic Review of Animal Models

2020 ◽  
pp. 219256822090168
Author(s):  
Mark J. Lambrechts ◽  
James L. Cook
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Animal Models ◽  
Motor Function ◽  
Spinal Cord Injuries ◽  
Inclusion Criteria ◽  
Improve Motor Function ◽  
Cord Injury ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Study Design: Systematic review. Objective: Spinal cord injuries (SCIs) resulting in motor deficits can be devastating injuries resulting in millions of health care dollars spent per incident. Nonsteroidal anti-inflammatory drugs (NSAIDs) are a potential class of drugs that could improve motor function after an SCI. This systematic review utilizes PRISMA guidelines to evaluate the effectiveness of NSAIDs for SCI. Methods: PubMed/MEDLINE, CINAHL, PsycINFO, Embase, and Scopus were reviewed linking the keywords of “ibuprofen,” “meloxicam,” “naproxen,” “ketorolac,” “indomethacin,” “celecoxib,” “ATB-346,” “NSAID,” and “nonsteroidal anti-inflammatory drug” with “spinal.” Results were reviewed for relevance and included if they met inclusion criteria. The SYRCLE checklist was used to assess sources of bias. Results: A total of 2960 studies were identified in the PubMed/MEDLINE database using the above-mentioned search criteria. A total of 461 abstracts were reviewed in Scopus, 340 in CINAHL, 179 in PsycINFO, and 7632 in Embase. A total of 15 articles met the inclusion criteria. Conclusions: NSAIDs’ effectiveness after SCI is largely determined by its ability to inhibit Rho-A. NSAIDs are a promising therapeutic option in acute SCI patients because they appear to decrease cord edema and inflammation, increase axonal sprouting, and improve motor function with minimal side effects. Studies are limited by heterogeneity, small sample size, and the use of animal models, which might not replicate the therapeutic effects in humans. There are no published human studies evaluating the safety and efficacy of these drugs after a traumatic cord injury. There is a need for well-designed prospective studies evaluating ibuprofen or indomethacin after adult spinal cord injuries.

A study of burden of care and its correlates among family members supporting relatives and loved ones with traumatic spinal cord injuries

2017 ◽  
Vol 31 (7) ◽  
pp. 948-956 ◽  
Author(s):  
Carmina Castellano-Tejedor ◽  
Pilar Lusilla-Palacios
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Life Satisfaction ◽  
Spinal Cord Injuries ◽  
Spinal Injury ◽  
Burden Of Care ◽  
Zarit Burden Interview ◽  
Resilience Scale ◽  
Cord Injury ◽  
The Future

Objective: To understand and describe in a sample of caregivers of persons with spinal cord injury, their burden of care, resilience and life satisfaction and to explore the relationship between these variables. Design: Cross-sectional design. Setting: One Spinal Cord Injury Acute Inpatient Unit from a general hospital. Subjects: Seventy-five relatives of persons with spinal cord injuries (84% women) with a mean age of 48.55 ( SD = 12.55) years. Interventions: None. Measures: Demographics (neurological loss and severity according to the American Spinal Injury Association criteria), the Zarit Burden Interview, the Resilience Scale and the Life Satisfaction Checklist. Results: All caregivers experienced feelings of different intensities of burden (52% mild-to-moderate, 43% moderate-to-severe and 5% severe), and none of them expressed little or no burden at the assessment moment. Caregivers’ main worries were “dependence” and “the future of the injured.” Resilience was medium-to-high (mean = 141.93, SD = 23.44) for the whole sample with just a minority of them revealing low (15%) or very low resilience (7%). The highest scores were obtained in relation to “caregivers’ independence” and “meaning of their lives.” Life satisfaction scores were medium-to-high (mean = 36.6, SD = 6). These scores were not related to demographics or the severity of the injury. Zarit Burden Interview scores were negatively correlated to Resilience Scale ( r = −.370, P = .001) and Life Satisfaction Checklist scores ( r = −.412, P < .001). Conclusion: More resilient and satisfied caregivers experienced lower burden. Burden is moderate-to-high and mainly related to uncertainty about the future, caregivers’ insecurity with caregiving and dependence of the injured.

Pediatric spinal injury: the very young

1988 ◽  
Vol 68 (1) ◽  
pp. 25-30 ◽  
Author(s):  
John R. Ruge ◽  
Grant P. Sinson ◽  
David G. McLone ◽  
Leonard J. Cerullo
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Spinal Injury ◽  
Causative Factor ◽  
Important Variable ◽  
Neurological Injury ◽  
Content Type ◽  
Significant Difference ◽  
Cord Injury

✓ Maturity of the spine and spine-supporting structures is an important variable distinguishing spinal cord injuries in children from those in adults. Cinical data are presented from 71 children aged 12 years or younger who constituted 2.7% of 2598 spinal cord-injured patients admitted to the authors' institutions from June, 1972, to June, 1986. The 47 children with traumatic spinal cord injury averaged 6.9 years of age and included 20 girls (43%). The etiology of the pediatric injuries differed from that of adult injuries in that falls were the most common causative factor (38%) followed by automobile-related injuries (20%). Ten children (21.3%) had spinal cord injury without radiographic abnormality (SCIWORA), whereas 27 (57%) had evidence of neurological injury. Complete neurological injury was seen in 19% of all traumatic pediatric spinal cord injuries and in 40% of those with SCIWORA. The most frequent level of spinal injury was C-2 (27%, 15 cases) followed by T-10 (13%, seven cases). Upon statistical examination of the data, a subpopulation of children aged 3 years or younger emerged. These very young children had a significant difference in level of injury, requirement for surgical stability, and sex distribution compared to 4- to 12-year-old children.

scholarly journals Spinal Injuries in Canadian Ice Hockey: Documentation of Injuries Sustained from 1943-1999

2004 ◽  
Vol 31 (4) ◽  
pp. 460-466 ◽  
Author(s):  
C.H. Tator ◽  
C.F. Provvidenza ◽  
L. Lapczak ◽  
J. Carson ◽  
D. Raymond
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Spinal Injury ◽  
Spinal Injuries ◽  
Ice Hockey ◽  
Common Mechanism ◽  
Cord Injury ◽  
Hockey Players ◽  
Rules Changes ◽  
Type Of Fracture

Objectives:Study objectives were: (a) to examine the causes and incidence of major spinal cord injuries sustained by ice hockey players; and (b) to add recently reported Canadian cases to the Canadian Ice Hockey Spinal Injury Registry to determine the effectiveness of prevention efforts.Methods:The study was a review of questionnaires returned retrospectively by physicians and other sources reporting ice hockey related spinal injuries in Canada. Physicians reported on the mechanism of injury, vertebral level of injury, presence of neurologic deficit, type of event, and type of fracture.Results:Between 1943 and 1999, 271 major spinal injuries were reported in Canadian ice hockey players, of which 49.0% occurred to players 16-20 years of age. Ontario has had a disproportionately large number of injuries compared to some provinces, especially Quebec. Of the spinal cord injuries, 65.8% resulted from colliding with the boards, and 36.6% were due to players being pushed or checked from behind. The recent survey shows that there has been a decline in the number of major spinal cord injuries in Canadian ice hockey, especially those causing paralysis due to checking or pushing from behind.Conclusion:Impact of the head with the boards after being checked or pushed from behind was the most common mechanism of spinal cord injury. Injury prevention programs are becoming effective in reducing the overall number of injuries, especially those due to checking from behind. Greater awareness of the occurrence and mechanisms of injury through educational programs and rules changes by organized hockey have reduced the annual incidence of catastrophic spinal injuries in Canadian ice hockey.

scholarly journals High-Dose Methylprednisolone for Acute Closed Spinal Cord Injury - Only a Treatment Option

2002 ◽  
Vol 29 (3) ◽  
pp. 227-235 ◽  
Author(s):  
H. Hugenholtz ◽  
D.E. Cass ◽  
M.F. Dvorak ◽  
D.H. Fewer ◽  
R.J. Fox ◽  
...  
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Treatment Option ◽  
Spinal Cord Injuries ◽  
High Dose ◽  
Cochrane Systematic Review ◽  
High Dose Methylprednisolone ◽  
Cord Injury ◽  
Level I

Background:A systematic review of the evidence pertaining to methylprednisolone infusion following acute spinal cord injury was conducted in order to address the persistent confusion about the utility of this treatment.Methods:A committee of neurosurgical and orthopedic spine specialists, emergency physicians and physiatrists engaged in active clinical practice conducted an electronic database search for articles about acute spinal cord injuries and steroids, from January 1, 1966 to April 2001, that was supplemented by a manual search of reference lists, requests for unpublished additional information, translations of foreign language references and study protocols from the author of a Cochrane systematic review and Pharmacia Inc. The evidence was graded and recommendations were developed by consensus.Results:One hundred and fifty-seven citations that specifically addressed spinal cord injuries and methylprednisolone were retrieved and 64 reviewed. Recommendations were based on one Cochrane systematic review, six Level I clinical studies and seven Level II clinical studies that addressed changes in neurological function and complications following methylprednisolone therapy.Conclusion:There is insufficient evidence to support the use of high-dose methylprednisolone within eight hours following an acute closed spinal cord injury as a treatment standard or as a guideline for treatment. Methylprednisolone, prescribed as a bolus intravenous infusion of 30 mg per kilogram of body weight over fifteen minutes within eight hours of closed spinal cord injury, followed 45 minutes later by an infusion of 5.4 mg per kilogram of bodyweight per hour for 23 hours, is only a treatment option for which there is weak clinical evidence (Level I- to II-1). There is insufficient evidence to support extending methylprednisolone infusion beyond 23 hours if chosen as a treatment option.

Long-term outcome of paediatric spinal cord injury

Trauma ◽  
2017 ◽  
Vol 19 (1_suppl) ◽  
pp. 75-82 ◽  
Author(s):  
Richa Kulshrestha ◽  
Naveen Kumar ◽  
J Roy Chowdhury ◽  
Aheed Osman ◽  
W El Masri
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Spinal Injury ◽  
Social Outcomes ◽  
Long Term Outcomes ◽  
Cord Injury ◽  
Post Traumatic ◽  
Clinical Records

Background Spinal cord injuries are relatively uncommon in children and evidence about long-term outcomes is limited. This study was performed to determine the frequency of common long-term complications in patients sustaining spinal injury in childhood (0–18 years) and who were followed up at a single dedicated spinal injuries centre in the UK. Method A retrospective review of clinical records of all patients injured at or less than 18 years of age between 1971 and 1999. Complications studied were renal, bowel, musculoskeletal, pressure ulcers and post-traumatic syringomyelia. Long-term social outcomes of independence, employment and driving were also assessed. Results Of 69 individuals (47 males, 22 females) the median age at injury was 17 years (range 0–18 y); 68% were older than 13 years at injury and 74% had traumatic injuries. Patients had an average duration of 27 years (12–43 years) of spinal injury – half had a neurological level of T6 and above, 80% had paraplegia and 20% had quadriplegia. Discussion Patients with both complete and incomplete spinal cord injury have minimal neurological recovery. Managing medical complications is vital as only 11.5% had normal voiding and 10.6% had normal bowel function. The incidence of skin ulcers increases with duration of spinal cord injury and scoliosis is higher in the non-traumatic injury group. Spasticity is observed in 66.6% and post-traumatic syringomyelia in 11.7%. Long-term social outcomes are good with 75% patients able to do independent care, 46% could drive and 39% managed employment or higher education. Conclusions This study documents the long-term outcomes and complications of spinal cord injuries sustained in childhood. With initial active physiological conservative management of the majority of patients, patient education and ongoing support the majority of patients achieved long-term survival and led independent and productive lives.

Spinal cord concussion

1990 ◽  
Vol 72 (6) ◽  
pp. 894-900 ◽  
Author(s):  
Thomas J. Zwimpfer ◽  
Mark Bernstein
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Spinal Injury ◽  
Cord Compression ◽  
Neurological Deficits ◽  
Content Type ◽  
Young Males ◽  
Cord Injury ◽  
Sensory Disturbances ◽  
Fine Print

✓ The hallmark of concussion injuries of the nervous system is the rapid and complete resolution of neurological deficits. Cerebral concussion has been well studied, both clinically and experimentally. In comparison, spinal cord concussion (SCC) is poorly understood. The clinical and radiological features of 19 SCC injuries in the general population are presented. Spinal cord injuries were classified as concussions if they met three criteria: 1) spinal trauma immediately preceded the onset of neurological deficits; 2) neurological deficits were consistent with spinal cord involvement at the level of injury; and 3) complete neurological recovery occurred within 72 hours after injury. Most cases involved young males, injured during athletics or due to falls. Concussion occurred at the two most unstable spinal regions, 16 involving the cervical spinal and three the thoracolumbar junction. Fifteen cases presented with combined sensorimotor deficits, while four exhibited only sensory disturbances. Many patients showed signs of recovery with the first few hours after injury and most had completely recovered within 24 hours. Only one case involved an unstable spinal injury. There was no evidence of ligamentous instability, spinal stenosis, or canal encroachment in the remaining 18 cases. Two patients, both children, suffered recurrent SCC injuries. No delayed deterioration or permanent cord injuries occurred. Spinal abnormalities that would predispose the spinal cord to a compressive injury were present in only one of the 19 cases. This suggests that, as opposed to direct cord compression, SCC may be the result of an indirect cord injury. Possible mechanisms are discussed.

scholarly journals Safety and effectiveness of early chemical deep venous thrombosis prophylaxis after spinal cord injury: pilot prospective data

2017 ◽  
Vol 43 (5) ◽  
pp. E21 ◽  
Author(s):  
Anthony M. DiGiorgio ◽  
Rachel Tsolinas ◽  
Mohanad Alazzeh ◽  
Jenny Haefeli ◽  
Jason F. Talbott ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Spinal Cord Injuries ◽  
Spinal Injury ◽  
Average Length ◽  
Injured Patient ◽  
Thrombosis Prophylaxis ◽  
Cord Injury ◽  
Hemorrhagic Complications

OBJECTIVESpinal cord injuries (SCIs) occur in approximately 17,000 people in the US each year. The average length of hospital stay is 11 days, and deep venous thrombosis (DVT) rates as high as 65% are reported in these patients. There is no consensus on the appropriate timing of chemical DVT prophylaxis for this critically injured patient cohort. The object of this study was to determine if low-molecular-weight heparin (LMWH) was safe and effective if given within 24 hours of SCI.METHODSThe Transforming Research and Clinical Knowledge in SCIs study is a prospective observational study conducted by the UCSF Brain and Spinal Injury Center. Protocol at this center includes administration of LMWH within 24 hours of SCI. Data were retrospectively reviewed to determine DVT rate, pulmonary embolism (PE) rate, and hemorrhagic complications.RESULTSForty-nine patients were enrolled in the study. There were 3 DVTs (6.1%), 2 PEs (4.1%), and no hemorrhagic complications. Regression modeling did not find an association between DVT and/or PE and age, American Spinal Injury Association grade, sex, race, or having undergone a neurosurgical procedure.CONCLUSIONSA standardized protocol in which LMWH is given to patients with SCI within 24 hours of injury is effective in keeping venous thromboembolism at the lower end of the reported range, and is safe, with a zero rate of adverse bleeding events.

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