scholarly journals Serial plasma DNA levels as predictors of outcome in patients with acute traumatic cervical spinal cord injury

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Hung-Chen Wang ◽  
Yu-Tsai Lin ◽  
Shih-Yuan Hsu ◽  
Nai-Wen Tsai ◽  
Yun-Ru Lai ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spinal Cord ◽  
Japanese Orthopaedic Association ◽  
Cervical Spinal Cord Injury ◽  
Acute Injury ◽  
Control Group ◽  
Plasma Dna ◽  
Post Injury ◽  
Cord Injury

Abstract Background Acute traumatic cervical spinal cord injury (SCI) is a leading cause of disability in adolescents and young adults worldwide. Evidence from previous studies suggests that circulating cell-free DNA is associated with severity following acute injury. The present study determined whether plasma DNA levels in acute cervical SCI are predictive of outcome. Methods In present study, serial plasma nuclear DNA (nDNA) and mitochondrial DNA (mtDNA) levels were obtained from 44 patients with acute traumatic cervical SCI at five time points from day 1 to day 180 post-injury. Control blood samples were obtained from 66 volunteers. Results Data showed a significant increase in plasma nDNA and mtDNA concentrations at admission in SCI patients compared to the control group. Plasma nDNA levels at admission, but not plasma mtDNA levels, were significantly associated with the Japanese Orthopaedic Association (JOA) score and Injury Severity Score in patients with acute traumatic cervical SCI. In patients with non-excellent outcomes, plasma nDNA increased significantly at days 1, 14 and 30 post-injury. Furthermore, its level at day 14 was independently associated with outcome. Higher plasma nDNA levels at the chosen cutoff point (> 45.6 ng/ml) predicted poorer outcome with a sensitivity of 78.9% and a specificity of 78.4%. Conclusions These results indicate JOA score performance and plasma nDNA levels reflect the severity of spinal cord injury. Therefore, the plasma nDNA assays can be considered as potential neuropathological markers in patients with acute traumatic cervical SCI.

Impact of cervical spinal cord injury on the relationship between the metabolism and ventilation in rats

2021 ◽  
Author(s):  
Tzu-Ting Chiu ◽  
Kun-Ze Lee
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Tidal Volume ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Male Rats ◽  
Whole Body ◽  
Post Injury ◽  
Chronic Injury ◽  
Cord Injury

Cervical spinal cord injury typically results in respiratory impairments. Clinical and animal studies have demonstrated that respiratory function can spontaneously and partially recover over time after injury. However, it remains unclear whether respiratory recovery is associated with alterations in metabolism. The present study was designed to comprehensively examine ventilation and metabolism in a rat model of spinal cord injury. Adult male rats received sham (i.e., laminectomy) or unilateral mid-cervical contusion injury (height of impact rod: 6.25 or 12.5 mm). Breathing patterns and whole-body metabolism (O2 consumption and CO2 production) were measured using a whole-body plethysmography system conjugated with flow controllers and gas analyzer at the acute (1 day post-injury), subchronic (2 weeks post-injury), and chronic (8 weeks post-injury) injury stages. The results demonstrated that mid-cervical contusion caused a significant reduction in the tidal volume. Although the tidal volume of contused animals can gradually recover, it remains lower than that of uninjured animals at the chronic injury stage. While O2 consumption and CO2 production were similar between uninjured and contused animals at the acute injury stage, these two metabolic parameters were significantly reduced in contused animals at the subchronic to chronic injury stages. Additionally, the relationships between ventilation, metabolism, and body temperature were altered by cervical spinal cord injury. These results suggest that cervical spinal cord injury causes a complicated reconfiguration of ventilation and metabolism that may enable injured animals to maintain a suitable homeostasis for adapting to the pathophysiological consequences of injury.

scholarly journals Timely Intubation With Early Prediction of Respiratory Exacerbation in Acute Traumatic Cervical Spinal Cord Injury

2021 ◽  
Author(s):  
Takafumi Yonemitsu ◽  
Azuna Kinoshita ◽  
Keiji Nagata ◽  
Mika Morishita ◽  
Tomoyuki Yamaguchi ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Post Injury ◽  
Airway Control ◽  
Airway Secretion ◽  
Respiratory Management ◽  
Cord Injury ◽  
Treatment Data

Abstract Background: Early routine intubation in motor-complete cervical spinal cord injury (CSCI) above the C5 level is a conventional protocol to prevent unexpected respiratory exacerbation (RE). However, in context of the recent advances in multidisciplinary respiratory management, the absolute indication for intubation in CSCI patients based on initial neurologic assessment is controversial because of the drawbacks of intubation. This study aimed to redetermine the most important predictor of RE following CSCI after admission without routine intubation among patients admitted with motor-complete injury and/or injury above the C5 level to ensure timely intubation. Methods: We performed a retrospective review of patients with acute traumatic CSCI admitted to our hospital without an initial routine intubation protocol from January 2013 to December 2017. CSCI patients who developed RE (defined as unexpected emergent intubation for respiratory resuscitation) were compared with those who did not. Baseline characteristics and severity of trauma data were collected. Univariate analyses were performed to compare treatment data and clinical outcomes between the two groups. Further, multivariate logistic regressions were performed with clinically important independent variables: motor-complete injury, neurologic level above C5, atelectasis, and copious airway secretion (CAS). Results: Among the analyzed 58 patients with CSCI, 35 (60.3%) required post-injury intubation and 1 (1.7%) died during hospitalization. Thirteen (22.4%) had RE in 3.5 days (mean) post-injury; 3 (37.5%) of eight motor-complete CSCI patients above C5 developed RE. Eleven of the 27 (40.7%) patients with motor-complete injury and five of the 22 (22.7%) patients with neurologic injury above C5 required emergency intubation at RE. Three of the eight CSCI patients with both risk factors (motor-complete injury above C5) resulted in emergent RE intubation (37.5%). CAS was an independent predictor for RE (odds ratio 7.19, 95% confidence interval 1.48–42.72, P=0.0144) in multivariate analyses. Conclusion: Timely intubation post-CSCI based on close attention to CAS during the acute 3-day phase may prevent RE and reduce unnecessary invasive airway control even without immediate routine intubation in motor-complete injury above C5.

scholarly journals The experiences of individuals with cervical spinal cord injury and their family during post-injury care in non-specialised and specialised units in UK

2020 ◽  
Author(s):  
Jackie McRae ◽  
Christina Smith ◽  
Anton Emmanuel ◽  
Suzanne Beeke
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spinal Cord ◽  
Family Members ◽  
Cervical Spinal Cord Injury ◽  
Specialist Care ◽  
Structured Interviews ◽  
Post Injury ◽  
Experience Of Care ◽  
Cord Injury

Abstract Background Individuals with acute cervical spinal cord injury require specialised interventions to ensure optimal clinical outcomes especially for respiratory, swallowing and communication impairments. This study explores the experiences of post-injury care for individuals with cervical spinal cord injury and their family members during admissions in specialised and non-specialised units in the United Kingdom.Methods Semi-structured interviews were undertaken with individuals with a cervical spinal cord injury and their family member, focussing on the experience of care across units. Eight people with spinal cord injury levels from C2 to C6, were interviewed in their current care settings. Six participants had family members present to support them. Interviews were audio-recorded and transcribed with data inputted into NVivo for thematic analysis.Results The study identified six themes from the participant interviews that highlighted different experiences of care in non-specialised and specialised settings. A number of these were related to challenges with the system, whilst others were about the personal journey of recovery. The themes were titled as: adjustment, transitions, “the golden opportunity”, “when you can’t eat”, communication, and “in the hands of the nurses and doctors”.Conclusions Whilst participants reported being well cared for in non-specialised units, they felt that they did not receive specialist care and this delayed their rehabilitation. Participants were dependent on healthcare professionals for information and care and at times lost hope for recovery. Staff in non-specialised units require training and guidance to help provide support for those with dysphagia and communication difficulties, as well as reassurance to patients and families whilst they wait for transfer to specialised units.

scholarly journals Cervical Spine AIS 6 – untreatable but survivable

2020 ◽  
Author(s):  
Oliver Kamp ◽  
O. Jansen ◽  
R. Lefering ◽  
M. Aach ◽  
C. Waydhas ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Mortality Rate ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Control Group ◽  
Multi Centre Study ◽  
Actual Mortality ◽  
Cord Injury ◽  
Trauma Scores

Abstract Background Trauma is a significant cause of death and impairment. The Abbreviated Injury Scale (AIS) differentiates the severity of trauma and is the basis for different trauma scores and prediction models. An AIS of 6 is described as currently untreatable or unsurvivable. While the majority of patients do not survive such injuries, there are several patients with a cervical spinal cord injury and an AIS of 6 that could be discharged from hospital despite the prognosis of trauma scores. For this reason, we evaluated these findings in a larger control group. Methods In a retrospective, multi-centre study, we used the data recorded in the TraumaRegister DGU® (TR-DGU) to select patients with a severe cervical spinal cord injury and an AIS of 3 to 6 between 2002 to 2015. We compared the estimated mortality rate according to the Revised Injury Severity Classification II (RISC II) score against the actual mortality rate for this group. Results Six hundred and twelve patients (0.6%) sustained a severe cervical spinal cord injury with an AIS of 6. The mean age was 57.8 ± 21.8 years and 441 (72.3%) were male. 580 (98.6%) suffered a blunt trauma, 301 patients were injured in a car accident and 29 through attempted suicide. Out of the 612 patients, 391 (63.9%) died from their injury and 170 during the first 24 hours. The group had a predicted mortality rate of 81.4%, but we observed an actual mortality rate of 63.9%. Conclusions An AIS of 6 with a complete cord syndrome above C3 as documented in the TR-DGU is survivable if patients get to the hospital alive, at which point they show a survival rate of more than 35%. Compared to the mortality predictive model of the RISC II score, they survived much more often than expected.

scholarly journals Clinical Trial of Human Fetal Brain-Derived Neural Stem/Progenitor Cell Transplantation in Patients with Traumatic Cervical Spinal Cord Injury

2015 ◽  
Vol 2015 ◽  
pp. 1-22 ◽  
Author(s):  
Ji Cheol Shin ◽  
Keung Nyun Kim ◽  
Jeehyun Yoo ◽  
Il-Sun Kim ◽  
Seokhwan Yun ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cell Transplantation ◽  
Cervical Spinal Cord ◽  
Fetal Brain ◽  
Tumor Formation ◽  
Cervical Spinal Cord Injury ◽  
Control Group ◽  
Cord Injury

In a phase I/IIa open-label and nonrandomized controlled clinical trial, we sought to assess the safety and neurological effects of human neural stem/progenitor cells (hNSPCs) transplanted into the injured cord after traumatic cervical spinal cord injury (SCI). Of 19 treated subjects, 17 were sensorimotor complete and 2 were motor complete and sensory incomplete. hNSPCs derived from the fetal telencephalon were grown as neurospheres and transplanted into the cord. In the control group, who did not receive cell implantation but were otherwise closely matched with the transplantation group, 15 patients with traumatic cervical SCI were included. At 1 year after cell transplantation, there was no evidence of cord damage, syrinx or tumor formation, neurological deterioration, and exacerbating neuropathic pain or spasticity. The American Spinal Injury Association Impairment Scale (AIS) grade improved in 5 of 19 transplanted patients, 2 (A → C), 1 (A → B), and 2 (B → D), whereas only one patient in the control group showed improvement (A → B). Improvements included increased motor scores, recovery of motor levels, and responses to electrophysiological studies in the transplantation group. Therefore, the transplantation of hNSPCs into cervical SCI is safe and well-tolerated and is of modest neurological benefit up to 1 year after transplants. This trial is registered with Clinical Research Information Service (CRIS), Registration Number:KCT0000879.

scholarly journals The Experiences of Individuals With Cervical Spinal Cord Injury and Their Family During Post-injury Care in Non-Specialised and Specialised Units in UK

2020 ◽  
Author(s):  
Jackie McRae ◽  
Christina Smith ◽  
Anton Emmanuel ◽  
Suzanne Beeke
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spinal Cord ◽  
Family Members ◽  
Cervical Spinal Cord Injury ◽  
Specialist Care ◽  
Structured Interviews ◽  
Post Injury ◽  
Experience Of Care ◽  
Cord Injury

Abstract BackgroundIndividuals with acute cervical spinal cord injury require specialised interventions to ensure optimal clinical outcomes especially for respiratory, swallowing and communication impairments. This study explores the experiences of post-injury care for individuals with cervical spinal cord injury and their family members during admissions in specialised and non-specialised units in the United Kingdom.MethodsSemi-structured interviews were undertaken with individuals with a cervical spinal cord injury and their family member, focussing on the experience of care across units. Eight people with spinal cord injury levels from C2 to C6, were interviewed in their current care settings. Six participants had family members present to support them. Interviews were audio-recorded and transcribed with data inputted into NVivo for thematic analysis.Results The study identified six themes from the participant interviews that highlighted different experiences of care in non-specialised and specialised settings. A number of these were related to challenges with the system, whilst others were about the personal journey of recovery. The themes were titled as: adjustment, transitions, “the golden opportunity”, “when you can’t eat”, communication, and “in the hands of the nurses and doctors”.ConclusionsWhilst participants reported being well cared for in non-specialised units, they felt that they did not receive specialist care and this delayed their rehabilitation. Participants were dependent on healthcare professionals for information and care and at times lost hope for recovery. Staff in non-specialised units require training and guidance to help provide support for those with dysphagia and communication difficulties, as well as reassurance to patients and families whilst they wait for transfer to specialised units.

scholarly journals Timely intubation with early prediction of respiratory exacerbation in acute traumatic cervical spinal cord injury

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Takafumi Yonemitsu ◽  
Azuna Kinoshita ◽  
Keiji Nagata ◽  
Mika Morishita ◽  
Tomoyuki Yamaguchi ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Post Injury ◽  
Airway Control ◽  
Airway Secretion ◽  
Respiratory Management ◽  
Cord Injury ◽  
Treatment Data

Abstract Background Early routine intubation in motor-complete cervical spinal cord injury (CSCI) above the C5 level is a conventional protocol to prevent unexpected respiratory exacerbation (RE). However, in the context of recent advances in multidisciplinary respiratory management, the absolute indication for intubation in patients with CSCI based on initial neurologic assessment is controversial because of the drawbacks of intubation. This study aimed to redetermine the most important predictor of RE following CSCI after admission without routine intubation among patients admitted with motor-complete injury and/or injury above the C5 level to ensure timely intubation. Methods We performed a retrospective review of patients with acute traumatic CSCI admitted to our hospital without an initial routine intubation protocol from January 2013 to December 2017. CSCI patients who developed RE (defined as unexpected emergent intubation for respiratory resuscitation) were compared with those who did not. Baseline characteristics and severity of trauma data were collected. Univariate analyses were performed to compare treatment data and clinical outcomes between the two groups. Further, multivariate logistic regression was performed with clinically important independent variables: motor-complete injury, neurologic level above C5, atelectasis, and copious airway secretion (CAS). Results Among 58 patients with CSCI, 35 (60.3%) required post-injury intubation and 1 (1.7%) died during hospitalization. Thirteen (22.4%) had RE 3.5 days (mean) post-injury; 3 (37.5%) of eight patients with motor-complete CSCI above C5 developed RE. Eleven of the 27 (40.7%) patients with motor-complete injury and five of the 22 (22.7%) patients with neurologic injury above C5 required emergency intubation at RE. Three of the eight CSCI patients with both risk factors (motor-complete injury above C5) resulted in emergent RE intubation (37.5%). CAS was an independent predictor for RE (odds ratio 7.19, 95% confidence interval 1.48–42.72, P = 0.0144) in multivariate analyses. Conclusion Timely intubation post-CSCI based on close attention to CAS during the acute 3-day phase may prevent RE and reduce unnecessary invasive airway control even without immediate routine intubation in motor-complete injury above C5.

scholarly journals Intermittent injection of Methylprednisolone Sodium Succinate in the treatment of Cervical Spinal Cord injury complicated with incomplete paraplegia

2019 ◽  
Vol 35 (1) ◽  
Author(s):  
Wei Wang ◽  
Baoshu Zuo ◽  
Haixia Liu ◽  
Limin Cui
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Adverse Reactions ◽  
Cervical Spinal Cord ◽  
Sodium Succinate ◽  
Cervical Spinal Cord Injury ◽  
Control Group ◽  
Observation Group ◽  
Methylprednisolone Sodium Succinate ◽  
Cord Injury

Objective: To evaluate the clinical efficacy and safety of intermittent injection of methylprednisolone sodium succinate in the treatment of cervical spinal cord injury complicated with incomplete paraplegia. Methods: Seventy-eight patients with cervical spinal cord injury complicated with incomplete paraplegia who were admitted between August 2016 and December 2017 were enrolled and grouped into an observation group and a control group using random number table, 39 in each group. Patients in the control group were given vertebral body decompression and bone grafting and internal fixation according to the severity of spinal cord compression, while patients in the observation group were treated by methylprednisolone sodium succinate in addition to the same treatment as the control group. The clinical efficacy and medicine associated adverse reactions were compared between the two groups. Results: The cure rate of the observation group was significantly higher than that of the control group (46.2% (18/39) vs. 20.5% (8/39)). After the treatment, the Japanese Orthopaedic Association (JOA) score and American Spinal Cord Injury Association (ASIA) score of the two groups after treatment were significantly higher compared to before treatment, and the scores of the observation group were much higher than those of the control group (P<0.05). The incidence of adverse reactions of the observation and control groups was 15.4% and 17.9% respectively, and the difference was not statistically significant (P>0.05). Conclusion: Intermittent injection of methylprednisolone sodium succinate has definite efficacy in treating cervical spinal cord injury complicated with incomplete paraplegia, with a low incidence of adverse reactions; hence it is worth promotion. How to cite this:Wang W, Zuo B, Liu H, Cui L. Intermittent injection of Methylprednisolone Sodium Succinate in the treatment of Cervical Spinal Cord injury complicated with incomplete paraplegia. Pak J Med Sci. 2019;35(1):---------. doi: https://doi.org/10.12669/pjms.35.1.211 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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