Incidence and severity of acute complications after spinal cord injury

2012 ◽  
Vol 17 (Suppl1) ◽  
pp. 119-128 ◽  
Author(s):  
Robert G. Grossman ◽  
Ralph F. Frankowski ◽  
Keith D. Burau ◽  
Elizabeth G. Toups ◽  
John W. Crommett ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Clinical Trials ◽  
Motor Vehicle ◽  
Spinal Injury ◽  
Vehicle Accidents ◽  
The North ◽  
Treatment And Prevention ◽  
Cord Injury ◽  
Study Population

Object The aim of this multicenter, prospective study was to determine the spectrum, incidence, and severity of complications during the initial hospitalization of patients with spinal cord injury. Methods The study was conducted at 9 university-affiliated hospitals that comprise the clinical centers of the North American Clinical Trials Network (NACTN) for Treatment of Spinal Cord Injury. The study population comprised 315 patients admitted to NACTN clinical centers between June 25, 2005, and November 2, 2010, who had American Spinal Injury Association (ASIA) Impairment Scale grades of A–D and were 18 years of age or older. Patients were managed according to a standardized protocol. Results The study population was 79% male with a median age of 44 years. The leading causes of injury were falls (37%) and motor vehicle accidents (28%). The distribution of initial ASIA grades were A (40%), B (16%), C (15%), and D (29%). Fifty-eight percent of patients sustained 1 or more severe, moderate, or mild complications. Complications were associated with more severe ASIA grade: 84% of patients with Grade A and 25% of patients with Grade D had at least 1 complication. Seventy-eight percent of complications occurred within 14 days of injury. The most frequent types of severe and moderate complications were respiratory failure, pneumonia, pleural effusion, anemia, cardiac dysrhythmia, and severe bradycardia. The mortality rate was 3.5% and was associated with increased age and preexisting morbidity. Conclusions Knowledge of the type, frequency, time of occurrence, and severity of specific complications that occur after spinal cord injury can aid in their early detection, treatment, and prevention. The data are of importance in evaluating and selecting therapy for clinical trials.

Optimization of the decision-making process for the selection of therapeutics to undergo clinical testing for spinal cord injury in the North American Clinical Trials Network

2012 ◽  
Vol 17 (Suppl1) ◽  
pp. 94-101 ◽  
Author(s):  
James Guest ◽  
James S. Harrop ◽  
Bizhan Aarabi ◽  
Robert G. Grossman ◽  
James W. Fawcett ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Decision Making ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Clinical Trials ◽  
North American ◽  
Clinical Testing ◽  
Data Set ◽  
The North ◽  
Cord Injury

The North American Clinical Trials Network (NACTN) includes 9 clinical centers funded by the US Department of Defense and the Christopher Reeve Paralysis Foundation. Its purpose is to accelerate clinical testing of promising therapeutics in spinal cord injury (SCI) through the development of a robust interactive infrastructure. This structure includes key committees that serve to provide longitudinal guidance to the Network. These committees include the Executive, Data Management, and Neurological Outcome Assessments Committees, and the Therapeutic Selection Committee (TSC), which is the subject of this manuscript. The NACTN brings unique elements to the SCI field. The Network's stability is not restricted to a single clinical trial. Network members have diverse expertise and include experts in clinical care, clinical trial design and methodology, pharmacology, preclinical and clinical research, and advanced rehabilitation techniques. Frequent systematic communication is assigned a high value, as is democratic process, fairness and efficiency of decision making, and resource allocation. This article focuses on how decision making occurs within the TSC to rank alternative therapeutics according to 2 main variables: quality of the preclinical data set, and fit with the Network's aims and capabilities. This selection process is important because if the Network's resources are committed to a therapeutic, alternatives cannot be pursued. A proposed methodology includes a multicriteria decision analysis that uses a Multi-Attribute Global Inference of Quality matrix to quantify the process. To rank therapeutics, the TSC uses a series of consensus steps designed to reduce individual and group bias and limit subjectivity. Given the difficulties encountered by industry in completing clinical trials in SCI, stable collaborative not-for-profit consortia, such as the NACTN, may be essential to clinical progress in SCI. The evolution of the NACTN also offers substantial opportunity to refine decision making and group dynamics. Making the best possible decisions concerning therapeutics selection for trial testing is a cornerstone of the Network's function.

North American Clinical Trials Network for the Treatment of Spinal Cord Injury: goals and progress

2012 ◽  
Vol 17 (Suppl1) ◽  
pp. 6-10 ◽  
Author(s):  
Robert G. Grossman ◽  
Elizabeth G. Toups ◽  
Ralph F. Frankowski ◽  
Keith D. Burau ◽  
Susan Howley
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Clinical Trials ◽  
Phase I ◽  
Data Management ◽  
North American ◽  
Conducting Phase ◽  
The North ◽  
Number Of Patients ◽  
Cord Injury

The North American Clinical Trials Network (NACTN) for the Treatment of Spinal Cord Injury is a consortium of 10 neurosurgery departments, a data management center, and a pharmacological center. The NACTN was established with the goal of bringing recent molecular and cell-based discoveries in neuroprotection and regeneration from the laboratory into clinical trials that optimize meaningful data outcomes and maximum safety to patients. The requirements of planning and executing clinical trials in spinal cord injury (SCI) and the steps that the NACTN has taken to address these requirements are discussed and illustrated in articles in this issue of the Journal of Neurosurgery: Spine. The progress that the NACTN has made in meeting these goals can be summarized as organizing a network of hospitals capable of enrolling a sufficient number of patients for conducting Phase I and II trials; creating a Data Management Center and a database of the natural history of recovery after SCI (at the time of this writing 485 patients were enrolled in the database); creating a database of the incidence and severity of complications that occur during acute and subacute treatment after SCI; developing a Pharmacological Center capable of performing pharmacokinetic and pharmacodynamic studies of therapeutic drugs; completing enrollment of 36 patients in NACTN's first clinical trial, a Phase I study of riluzole, a neuroprotective drug; and performing pharmacokinetic and pharmacodynamic studies of riluzole in acute SCI.

Spine Trauma

2019 ◽  
pp. 255-262
Author(s):  
Timur M. Urakov ◽  
Michael Y. Wang
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Motor Vehicle ◽  
Fluid Management ◽  
The Elderly ◽  
Autonomic Dysreflexia ◽  
Spine Trauma ◽  
Vehicle Accidents ◽  
Cord Injury ◽  
Anaesthesia Care

The estimated global incidence of spinal cord injury (SCI) is 250,000 to 500,000 people a year. North America tends to have higher rates of incidence of SCI than Europe. Statistically, young adults and the elderly are more likely to be injured. Motor vehicle accidents are the leading cause of SCI in the world, followed by falls, violence, sports, recreational activities, and iatrogenic sources. This chapter on spine trauma includes elements of anatomy and anaesthesia care for acute cervical spine cord injury (including airway management, blood pressure management, fluid management, hypothermia, monitoring, and steroids). It also covers anaesthesia care for chronic spinal cord injury (including autonomic dysreflexia, physiological changes in chronic SCI patients, and obstetrics).

scholarly journals Outcome in patients undergoing surgery for spinal injury in an Ethiopian hospital

2015 ◽  
Vol 23 (6) ◽  
pp. 772-779 ◽  
Author(s):  
Martin Andreas Lehre ◽  
Lars Magnus Eriksen ◽  
Abenezer Tirsit ◽  
Segni Bekele ◽  
Saba Petros ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Surgical Treatment ◽  
Motor Vehicle ◽  
Spinal Injury ◽  
Addis Ababa ◽  
Cord Injury ◽  
Spine Injuries ◽  
Tract Infections

OBJECT The objective of this study was to investigate epidemiology and outcome after surgical treatment for spinal injuries in Ethiopia. METHODS Medical records of patients who underwent surgery for spine injuries at Myungsung Christian Medical Center in Addis Ababa, Ethiopia, between January 2008 and September 2012 were reviewed retrospectively. Assessment of outcome and complications was determined from patient consultations and phone interviews. RESULTS A total of 146 patients were included (129 males, 17 females). Their mean age was 31.7 years (range 15–81 years). The leading cause of injury was motor vehicle accidents (54.1%), and this was followed by falls (26.7%). The most common injury sites were lumbar (41.1%) and cervical (34.2%) regions of the spine. In 21.2% of patients, no neurological deficit was present before surgery, 46.6% had incomplete spinal cord injury (American Spinal Injury Association [ASIA] Impairment Scale [AIS] Grade B-D), and 32.2% had complete spinal cord injury (AIS Grade A). Follow-up was hampered by suboptimal infrastructure, but information regarding outcome was successfully obtained for 110 patients (75.3%). At follow-up (mean 22.9 months; range 2–57 months), 25 patients (17.1%) were confirmed dead and 85 patients (58.2%) were alive; 49 patients (33.6%) underwent physical examination. At least 8 of the 47 patients (17.0%) with a complete injury and 29 of the 68 patients (42.6%) with an incomplete injury showed neurological improvement. The reported incidences of pressure wounds, recurrent urinary tract infections, pneumonia, and thromboembolic events were 22.5%, 13.5%, 5.6%, and 1.1%, respectively. CONCLUSIONS Patients showed surprisingly good recovery considering the limited resources. Surgical treatment for spine injuries in Ethiopia is considered beneficial.

scholarly journals SPINAL CORD TRAUMA PATIENTS TREATED IN A TERTIARY HOSPITAL IN PALMAS, BRAZIL

2015 ◽  
Vol 14 (3) ◽  
pp. 214-217
Author(s):  
Danilo Lopes Castro ◽  
Gustavo Fernandes Leobas ◽  
Maíse Santana Tolentino Marciano Araujo ◽  
Itágores Hoffman Lopes Sousa Coutinho ◽  
Márcio Antônio de Sousa Figueiredo
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Motor Vehicle ◽  
Spinal Injury ◽  
Tertiary Hospital ◽  
Alcoholic Beverages ◽  
Neurological Deficits ◽  
Trauma Patients ◽  
Cord Injury ◽  
Epidemiological Profile

Objective:Traumatic spinal cord injury is one of the leading causes of disability worldwide, mainly related to automobile accidents. It was decided to establish a clinical-epidemiological profile of spinal cord injury (SCI) in Palmas, Brazil.Method:Prospective study at the Public General Hospital of Palmas (HGPP), including all patients admitted in this hospital from January 2011 to February 2012.Results:They refer to 59 patients, of whom 81.4% were men and 47.4% of the victims had up to 40 years. The main mechanism of injury was motor vehicle accidents involving motorcycles. Clinically, the vertebral segment C4-C7 was the most damaged, and most patients were admitted with spinal injury and no neurological deficit (Frankel E).Conclusions:Primary involvement of young men in working age, trauma mainly due to car accidents that are usually associated with the use of alcoholic beverages. Patients admitted with more severe neurological deficits have evolved to milder impairments after conservative or surgical treatment.

scholarly journals Potential neuroprotective therapies in traumatic acute spinal injury: an integrative review

2021 ◽  
pp. 51919-51923
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Clinical Trials ◽  
Physical Dependence ◽  
Spinal Injury ◽  
Channel Blockers ◽  
Spinal Cord Trauma ◽  
Neuroprotective Agents ◽  
Neuroprotective Effects ◽  
Cord Injury

Introduction: Acute traumatic spinal cord injury is a complex injury affecting the nervous tissue of the spinal cord, vertebrae, joints, innervation and local vasculature, resulting in high mortality, physical dependence, stress, financial losses, lifelong risk of medical complications and reduced longevity. The complexity of the clinical repercussions of acute spinal cord trauma (SCI) makes early interventions necessary to ensure better prognosis. Emerging therapies with neuroprotective agents emerge 1,2,3 Methodology: For the integrative literature review, the PubMed databases were used, Scielo, Google Scholar, Cochrane and the descriptors “spinal injury”; “spinal cord trauma”; “neuroprotective” and “drug therapy”. Results: Therapies with corticosteroids, ion channel blockers, agonists and antagonists of neurotransmitters, cellular and genetic agents, vitamin D, progesterone, erythropoietin and caspase inhibitors demonstrated different neuroprotective effects involving reduction of secondary spinal cord injury and acceleration of neuronal recovery. in uneven research phases. Conclusion: It is concluded that preclinical studies with neuroprotectors as a potential treatment for TRM are promising, however, not all of them evolve into clinical trials, which limits the application of these therapies in humans. Therefore, it is necessary to improve research and clinical trials related to the use of neuroprotective agents in the management of traumatic acute spinal cord injury.

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