scholarly journals Design and Retrospective Application of a Spine Trauma DVT Prophylaxis Protocol on Level 1 Trauma Center Patient Database

2021 ◽  
pp. 219256822097913
Author(s):  
Scott Nimmons ◽  
James Rizkalla ◽  
Jaicus Solis ◽  
Jonathan Dawkins ◽  
Ishaq Syed
Keyword(s):  
Spinal Cord ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Vertebral Column ◽  
Spinal Cord Injuries ◽  
Spine Trauma ◽  
Filter Placement ◽  
Dvt Prophylaxis ◽  
Cord Injury ◽  
The Impact

Study Design: Systematic literature review. Objectives: The impact of thromboembolic disease on the morbidity and mortality of patients with acute spinal cord injury is well documented, with rates as high as 67%-100% among untreated patients. The efficacy of mechanical prophylaxis as a stand-alone measure has been questioned, so we sought to determine a safe perioperative window for chemical anticoagulation use after spine surgery. Many surgeons have concerns anticoagulants may cause post-operative hematoma. Methods: A systematic literature review was performed, ultimately yielding 13 articles. Based on the existing literature and input from our multidisciplinary institutional trauma committee, a Spine Trauma DVT Prophylaxis Protocol was developed. Results: Effort was placed to identify cases within our institution in which patients suffered vertebral column fractures and/or spinal cord injuries. Of these 466 vertebral column fractures and/or spinal cord injuries, 4 patients were identified and diagnosed with DVTs while admitted. Conclusions: Of these patients, there is a clear dilemma with regard to safety of chemoprophylaxis use versus risk of developing a DVT. Though none of the patients developed a PE, utilizing the protocol would have led to earlier IVC filter placement or initiation of a VTE surveillance protocol in 2 of the patients. Initiation of enoxaparin before surgery in one patient (despite delay of surgical timing) may have avoided his subsequent LUE DVT. Though not appropriate for all clinical scenarios, we are confident that our treatment algorithm will prove beneficial for patient care in avoiding DVTs and helping trauma surgeons with evidence-based clinical decision making.

scholarly journals Acquisition of a precision walking skill and the impact of proprioceptive deficits in people with motor-incomplete spinal cord injury

2019 ◽  
Vol 121 (3) ◽  
pp. 1078-1084 ◽  
Author(s):  
Amanda E. Chisholm ◽  
Taha Qaiser ◽  
Alison M. M. Williams ◽  
Gevorg Eginyan ◽  
Tania Lam
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Visual Feedback ◽  
Spinal Cord Injuries ◽  
Sensory Function ◽  
Joint Position ◽  
Incomplete Spinal Cord Injury ◽  
Cord Injury ◽  
Rate Of Learning ◽  
The Impact

Many people with motor-incomplete spinal cord injury (m-iSCI) experience difficulty navigating obstacles, such as curbs and stairs. The ability to relearn walking skills may be limited by proprioceptive deficits. The purpose of this study was to determine the capacity of participants to acquire a precision walking skill, and to evaluate the influence of proprioceptive deficits on the skill acquisition in individuals with m-iSCI. Sixteen individuals with m-iSCI and eight controls performed a precision walking task that required matching their foot height to a target during the swing phase. Proprioceptive deficits were quantified at the hip and knee for joint position and movement detection sense. Participants completed 600 steps of training with visual feedback. Pretraining and posttraining tests were conducted without visual feedback, along with a transfer test with an ankle weight. Posttraining and transfer tests were repeated 1 day later. Participants returned to the laboratory 1 wk later to repeat the training. Performance was calculated as the vertical distance between the target and actual foot height for each step. The posttraining and transfer performances were similar between groups. However, participants with m-iSCI had a slower rate of acquisition to achieve a similar performance level compared with controls. Acquisition rate and posttraining performance of the precision walking task were related to lower limb joint position sense among SCI participants. Although they can achieve a similar level of performance in a precision walking task, proprioceptive deficits impair the rate of learning among individuals with m-iSCI compared with able-bodied controls. NEW & NOTEWORTHY People with motor-incomplete spinal cord injuries are able to achieve the same level of performance accuracy on a precision walking task as able-bodied controls; however, the rate of learning is slower, indicating that more practice is required to stabilize performance. Our findings also show a relationship between impaired sensory function and reduced accuracy when performing a precision walking task after spinal cord injury.

Men’s Adjustment to Spinal Cord Injury: The Unique Contributions of Conformity to Masculine Gender Norms

2009 ◽  
Vol 4 (2) ◽  
pp. 157-166 ◽  
Author(s):  
Shaun Michael Burns ◽  
Sigmund Hough ◽  
Briana L. Boyd ◽  
Justin Hill
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Gender Norms ◽  
The United States ◽  
Future Research ◽  
Masculine Norms ◽  
Cord Injury ◽  
Future Research Directions ◽  
The Impact

Men constitute 82% of the approximately 250,000 people in the United States living with a spinal cord injury. Unfortunately, however, little is known about the impact of men’s adherence to gender norms on their adjustment to such injuries. The present investigation examined the utility of masculine norms in explaining variance in depression beyond that accounted for by commonly identified predictors of men’s adjustment following spinal cord injury. As hypothesized, results suggested that men’s adherence to masculine norms accounted for unique variance in their depression scores beyond that contributed by social support, environmental barriers/access, and erectile functioning. Respondents who adhered to norms stressing the primacy of men’s work demonstrated lower rates of depression, whereas those who conformed to norms for self-reliance demonstrated higher depression scores. The authors discuss future research directions and potential psychotherapeutic strategies for working with men with spinal cord injuries.

scholarly journals How to generate graded spinal cord injuries in swine?: Tools and procedures

2021 ◽  
Author(s):  
Mark Züchner ◽  
Manuel J. Escalona ◽  
Lena Hammerlund Teige ◽  
Evangelos Balafas ◽  
Lili Zhang ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Animal Models ◽  
Functional Outcome ◽  
Spinal Cord Injuries ◽  
Large Body ◽  
Swine Model ◽  
Large Animal ◽  
Large Animal Models ◽  
Cord Injury ◽  
The Impact

Spinal cord injury (SCI) is a medically, psychologically and socially disabling condition. A large body of our knowledge on the basic mechanisms of SCI has been gathered in rodents. For preclinical validation of promising therapies, the use of animal models that are closer to humans has several advantages. This has promoted a more intensive development of large animal models for SCI during the past decade. We have recently developed a multimodal SCI apparatus for large animals that generated biomechanically reproducible impacts in vivo. It is composed of a spring-load impactor and support systems for the spinal cord and the vertebral column. We now present the functional outcome of farm pigs and minipigs injured with different lesion strengths. There was a correlation between the biomechanical characteristics of the impact, the functional outcome, and the tissue damage observed several weeks after injury. We also provide a detailed description of the procedure to generate such a SCI in both farm pigs and minipigs, in the hope to ease the adoption of the swine model by other research groups.

A study of whether individual and dyadic relations between spirituality and resilience contribute to psychological adjustment among individuals with spinal cord injuries and their family members

2019 ◽  
Vol 33 (9) ◽  
pp. 1503-1514 ◽  
Author(s):  
Kate Fiona Jones ◽  
Grahame Simpson ◽  
Lynne Briggs ◽  
Pat Dorsett ◽  
Malcolm Anderson
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Satisfaction With Life ◽  
Family Members ◽  
Well Being ◽  
Satisfaction With Life Scale ◽  
Cord Injury ◽  
Spiritual Well Being ◽  
The Impact

Objective: To test a model of spiritual well-being and resilience among individuals with spinal cord injuries and their family members. Design: Prospective cross-sectional observational data were analyzed by structural equation modelling. Setting: Inpatient and community services at one rehabilitation hospital. Subjects: Individual with spinal cord injury ( n = 50) and family member ( n = 50) dyads. Interventions: Standard rehabilitation, both inpatient and community. Main measure(s): Functional assessment of chronic illness therapy – spiritual well-being scale – expanded, Connor–Davidson resilience scale, positive and negative affect scale, depression anxiety and stress scale–21, satisfaction with life scale. Results: Median time post-injury was 8.95 months (IQR (interquartile range) = 14.15). Individuals with spinal cord injury and family members reported high scores for both spiritual well-being (66.06 ± 14.89; 68.42 ± 13.75) and resilience (76.68 ± 13.88; 76.64 ± 11.75), respectively. Analysis found the model had acceptable fit (e.g. chi-square goodness of fit statistic = 38.789; P = .263). For individuals with spinal cord injury, spiritual well-being was positively associated with resilience which, in turn, was associated with increasing positive affect and satisfaction with life. Among family members, spiritual well-being was positively associated with resilience. Resilience was then associated with lowered levels of depression and mediated the impact of depression on satisfaction with life. Limited evidence was found for mutual dyadic links, with the only significant pathway finding that resilience in the individual with spinal cord injury was associated with increased satisfaction with life among family members. Conclusion: Increased spirituality and resilience make a significant contribution (both independently and in combination) to positive psychological outcomes for both individuals with spinal cord injury and their family members.

Cervical Spine Trauma Management

2018 ◽  
Vol 1 (2) ◽  
pp. 14
Author(s):  
Rully Hanafi Dahlan ◽  
Sevline Estethia Ompusunggu ◽  
Farid Yudoyono
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Early Mobilization ◽  
Cord Compression ◽  
Spinal Injuries ◽  
Spine Injury ◽  
Spine Trauma ◽  
Neurological Improvement ◽  
Operative Care ◽  
Cord Injury

The incidence of spine injury following accidents are still very high in developing countries. Many problems occur after the accident including primary intervention on the scene, transportation to the public primary hospital, the referral system, and finally, the management at the central hospital.Cervical spinal cord injuries represent 20-33% of total spinal injuries with the prevalence of the subaxial levels. In patients with a preoperative neurological deficit due to spine trauma, in case of spinal cord compression or instability, surgery is often the treatment of choice to grant a chance of neurological recovery, early mobilization, and faster return to usual daily activities compared to the conservative treatment. In the past, many authors suggested a delayed surgical treatment to reduce postoperative complications rate, but recent studies have shown that an early decompression (<72 h) may facilitate a postoperative neurological improvement probably due to the prevention of the secondary mechanisms of damage in acute SCI.In the context of the advanced management of spinal injuries, the main points of the focused assessment, the important waypoints of a full classification of the skeletal and spinal cord injury, the principles of early prioritization and decision making, the outline of the surgical strategy including indications, timing, approaches, technique and post-operative care, and the outline principles of rehabilitation. The authors in this paper try to summarize and create a guideline of management, based on experience in a regional centre.

What do we currently know about thoracic spinal cord injury recovery and outcomes? A systematic review

2012 ◽  
Vol 17 (Suppl1) ◽  
pp. 52-64 ◽  
Author(s):  
Richard J. Bransford ◽  
Jens R. Chapman ◽  
Andrea C. Skelly ◽  
Ellen M. VanAlstyne
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Poor Quality ◽  
Pulmonary Complications ◽  
Level Of Evidence ◽  
Thoracic Spinal Cord ◽  
Strength Of Evidence ◽  
Thoracic Spinal ◽  
Cord Injury ◽  
The Impact

Object The purpose of this paper was to systematically review and critically appraise the evidence for whether there are differences in outcomes or recovery after thoracic spinal cord injuries (SCIs) based on the spinal level, the timing of intervention, or cause of SCI. Methods Systematic searches were conducted using PubMed/MEDLINE through January 5, 2012. From 486 articles identified, 10 included data on the population of interest. Included studies were assigned a level of evidence (LOE) rating based on study quality, and an overall strength of evidence was assessed. To estimate the effect of injury level on patient outcomes, the relative risk and risk difference were calculated when data were available. Results From 486 citations identified, 3 registry studies and 7 retrospective cohort studies met the inclusion criteria. All were rated as being of poor quality (LOE III). Limited literature exists on the epidemiology of traumatic and nontraumatic SCI. Few studies evaluated outcomes based on SCI level within the thoracic spine. Pulmonary complications and thromboembolic events were less common in persons with lower thoracic SCI (T7–12) than in those with higher thoracic SCI (T1–6) in 2 large studies, but no differences were found in functional outcomes in 4 smaller studies. Patients undergoing earlier surgery (< 72 hours) may have fewer ventilator, ICU, and hospital days than those undergoing later surgery. One small study of SCI during repair of aortic aneurysm compared with traumatic SCI reported similar outcomes for both groups. There are substantial deficiencies in the scientific literature on thoracic SCI in regard to assessment, outcomes ratings, and effectiveness of therapy. Conclusions The overall strength of evidence for all outcomes reported is low. Definitive conclusions should not be drawn regarding the prognosis for outcome and recovery after thoracic SCI. From a physiological standpoint, additional methodologically rigorous studies that take into consideration various levels of injury in more anatomically and physiologically relevant form are needed. Use of validated, comprehensive outcomes tools are important to improve our understanding of the impact of thoracic SCI and aid in examining factors in recovery from thoracic SCI.

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