Pediatric spinal trauma

1988 ◽  
Vol 68 (1) ◽  
pp. 18-24 ◽  
Author(s):  
Mark N. Hadley ◽  
Joseph M. Zabramski ◽  
Carol M. Browner ◽  
Harold Rekate ◽  
Volker K. H. Sonntag
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Recovery Of Function ◽  
Spinal Trauma ◽  
Spine Injury ◽  
Injury Patterns ◽  
Content Type ◽  
Cord Injury ◽  
Biomechanical Features

✓ A review of 122 pediatric cases of vertebral column and spinal cord injuries is presented. These relatively uncommon injuries can be characterized by four distinct injury patterns: fracture only, fracture with subluxation, subluxation only, and spinal cord injury without radiographic abnormality. The immature pediatric spine has several anatomical and biomechanical features that distinguish it from the mature adolescent spine and, accordingly, the frequency of the injury type, the level of spine injury, and the incidence of neurological compromise were found to vary with the age of the patient. Follow-up data were obtained in 93% of the cases (median duration 44 months). No patient was made worse by treatment, 89% of the patients with incomplete myelopathy on admission were improved on their last examination, and 20% of the patients with a complete myelopathy had evidence of significant recovery of function. The authors conclude that the outcome after pediatric spinal trauma is good.

Late neurological changes following traumatic spinal cord injury

1988 ◽  
Vol 69 (3) ◽  
pp. 399-402 ◽  
Author(s):  
Joseph M. Piepmeier ◽  
N. Ross Jenkins
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Neurological Status ◽  
Neurological Function ◽  
Traumatic Spinal Cord Injury ◽  
Content Type ◽  
Cord Injury ◽  
Fine Print

✓ Sixty-nine patients with traumatic spinal cord injuries were evaluated for changes in their functional neurological status at discharge from the hospital, and at 1 year, 3 years, and 5+ years following injury. The neurological examinations were used to classify patients' spinal cord injury according to the Frankel scale. This analysis revealed that the majority of improvement in neurological function occurred within the 1st year following injury; however, changes in the patients' status continued for many years. Follow-up examinations at an average of 3 years postinjury revealed that 23.3% of the patients continued to improve, whereas 7.1% had deteriorated compared to their status at 1 year. An examination at an average of 5+ years demonstrated further improvement in 12.5%, with 5.0% showing deterioration compared to the examinations at 3 years. These results demonstrate that, in patients with spinal trauma, significant changes in neurological function continue for many years.

Therapeutic trial of hypercarbia and hypocarbia in acute experimental spinal cord injury

1984 ◽  
Vol 61 (5) ◽  
pp. 925-930 ◽  
Author(s):  
Ronald W. J. Ford ◽  
David N. Malm
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Mortality Rates ◽  
Therapeutic Trial ◽  
Tissue Preservation ◽  
Content Type ◽  
Experimental Spinal Cord Injury ◽  
Cord Injury ◽  
Fine Print

✓ Hypocarbia, normocarbia, or hypercarbia was maintained for an 8-hour period beginning 30 minutes after acute threshold spinal cord injuries in cats. No statistically significant differences in neurological recovery or histologically assessed tissue preservation were found among the three groups of animals 6 weeks after injury. No animal recovered the ability to walk. It is concluded that maintenance of hypercarbia or hypocarbia during the early postinjury period is no more therapeutic than maintenance of normocarbia. Mortality rates and tissue preservation data suggest, however, that postinjury hypocarbia may be less damaging than hypercarbia.

A reproducible spinal cord injury model in the cat

1983 ◽  
Vol 59 (2) ◽  
pp. 268-275 ◽  
Author(s):  
Ronald W. J. Ford
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Sharp Transition ◽  
Content Type ◽  
Spinal Cord Injury Model ◽  
Injury Model ◽  
Cord Injury ◽  
Weight Drop ◽  
Future Evaluation

✓ Allen's weight-drop method for producing experimental spinal cord injuries was improved by placing a curved stainless steel plate anterior to the spinal cord to provide a smooth, hard surface for the receipt of posterior cord impact. In addition, an electronic circuit was used to ensure that cord injury was produced by a single impact, thereby enhancing the reproducibility of the injury mechanism. Using a spinal cord injury model with these modifications, the author found that the recovery of hindlimb function and the histopathological appearance of the injured cord 6 weeks after upper lumbar injury were closely related to injury magnitude. The curve of functional recovery versus injury magnitude has a sharp transition centered at 10 gm × 15 cm, and indicates that an injury of 10 gm × 20 cm produces a “threshold” lesion suitable for the future evaluation of spinal cord treatment methods.

Evolution of tissue damage in compressive spinal cord injury in rats

1987 ◽  
Vol 66 (4) ◽  
pp. 595-603 ◽  
Author(s):  
Hideaki Iizuka ◽  
Hirotaka Yamamoto ◽  
Yuzo Iwasaki ◽  
Teiji Yamamoto ◽  
Hidehiko Konno
Keyword(s):  
Spinal Cord ◽  
Tissue Damage ◽  
Spinal Cord Injuries ◽  
Sodium Dodecyl ◽  
Membrane Integrity ◽  
Secondary Degeneration ◽  
Content Type ◽  
Cell Membrane Integrity ◽  
Cord Injury ◽  
Mechanical Insult

✓ The evolution of tissue damage in compressive spinal cord injuries in rats was studied using an immunohistochemical technique and by sodium dodecyl sulfate-polyacrylamide gel electropheresis (SDS-PAGE) analysis. The rupture of small vessels accompanied by intense tissue permeation of serum components in and around the hemorrhagic foci appeared to be immediate consequences of the mechanical insult. The loss of cell membrane integrity in neural elements became evident within 1 hour after injury as shown by the diffuse albumin-immunoreactivity of the cytoplasm. At the site of mechanical insult, approximately 30% of the neurofilament proteins were degraded within 1 hour, and 70% of them were lost within 4 hours after injury. A large number of cells positive for glial fibrillary acidic protein were found to demarcate the injured tissue within 1 hour after injury. The progression of tissue damage largely subsided within 48 hours. One week after, injury, severe degeneration of the ascending tracts in the posterior funiculus was shown clearly by axon staining and less convincingly by myelin staining. Secondary degeneration of the corticospinal tract in distal segments remained inconspicuous for up to 3 months.

Neurological prognosis after traumatic quadriplegia

1979 ◽  
Vol 50 (5) ◽  
pp. 611-616 ◽  
Author(s):  
Frederick M. Maynard ◽  
Glenn G. Reynolds ◽  
Steven Fountain ◽  
Conal Wilmot ◽  
Richard Hamilton
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Injury ◽  
Head Injuries ◽  
Gunshot Wounds ◽  
Neurological Impairment ◽  
Treatment Protocols ◽  
Content Type ◽  
Cord Injury

✓ Between January, 1974, and December, 1976, 123 patients with traumatic quadriplegia were admitted to the California Regional Spinal Cord Injury Care System. The spinal cord injury resulted from gunshot wounds in five, from a stab wound in one, from neck injuries with no bone damage seen on x-ray studies in 10, and from fracture dislocations of the cervical spine in 107. One-year follow-up information was available on 114 patients. Neurological impairment using the Frankel classification system was compared at 72 hours postinjury to the 1-year follow-up examination. Fifty of 62 patients with complete injury at 72 hours were unchanged at 1 year. Five of these 62 patients had developed motor useful function in the legs or became ambulatory by 1 year, but all had sustained serious head injuries at the time of their trauma making initial neurological assessment unreliable. Ten percent of all cases had combined head injury impairing consciousness. Among 103 cognitively intact patients, none with complete injury at 72 hours were walking at 1 year. Of patients with sensory incomplete function at 72 hours postinjury, 47% were walking at 1 year; 87% of patients with motor incomplete function at 72 hours postinjury were walking at 1 year. Spinal surgery during the first 4 weeks postinjury did not improve neurological recovery. A method of analyzing neurological and functional outcomes of spinal cord injury is presented in order to more accurately evaluate the results of future treatment protocols for acute spinal injury.

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.

DREZ lesions for relief of pain related to spinal cord injury

1986 ◽  
Vol 65 (4) ◽  
pp. 465-479 ◽  
Author(s):  
Allan H. Friedman ◽  
Blaine S. Nashold
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Pain Relief ◽  
Intractable Pain ◽  
Content Type ◽  
Root Entry Zone ◽  
Pain Syndromes ◽  
Cord Injury ◽  
Good Pain Relief

✓ Fifty-six patients with intractable pain following a spinal cord injury were treated with dorsal root entry zone (DREZ) lesions. After a follow-up period ranging from 6 months to 6 years, 50% of patients had good pain relief. Certain pain syndromes tended to respond better to DREZ lesions than did others. Patients with pain extending caudally from the level of the injury and patients with unilateral pain were most likely to obtain pain relief from the procedure; diffuse pain and predominant sacral pain did not respond as well.

scholarly journals (A313) Role of Physiatrists in Post Disaster Scenarios - Lessons Learned from Pakistan, China and Haiti Earthquakes

2011 ◽  
Vol 26 (S1) ◽  
pp. s105-s105
Author(s):  
F.A. Rathore ◽  
C. O'connell ◽  
J. Li
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Community Integration ◽  
Functional Restoration ◽  
Lessons Learned ◽  
Spinal Trauma ◽  
Trauma Patients ◽  
Cord Injury ◽  
Post Disaster

IntroductionPhysical Medicine and Rehabilitation is a goal oriented and patient centered specialty which focuses on functional restoration and quality of life of persons with disability. The patterns of injuries among survivors of recent disasters have, range from mild (single limb fracture) to catastrophic (spinal cord injury, amputation, traumatic brain injury). Historically physiatrists have not participated the acute disaster management phase or in the emergent post disaster rehabilitation planning. This task is usually relegated to the trauma, orthopedic and general surgeons.MethodologyAuthors had firsthand experience in the acute and emergent care and rehabilitation of trauma patients after Pakistan, China and Haiti earthquakes. An electronic literature search (English, 1965–2010, Key words: trauma, rehabilitation, disability, spinal cord injury, amputation, disaster, nerve injury) was carried out. Experience sharing through committees, online forum, and communications were conducted with physiatry colleagues internationally.ResultsIn these three recent earthquakes, Physiatrists provided direct patient care, including guidance in the evacuation of survivors with pre-existing disabilities, transport of persons with spinal trauma, treatment of wounds, fractures, pain, spinal trauma patients and persons with amputations. Physiatrists devised appropriate plans for conservative management of fractures. Education of local staff and coordination of rehabilitation was initiated. Monitoring, prevention and treatment of secondary complications including prolonged immobility, pressure ulcers, chronic pain, urinary, bowel and respiratory dysfunction was performed. Physiatrists helped in patient counseling and family education.ConclusionPhysiatrists by virtue of their training and skills are in a better position to manage the disabilities, including direction of rehabilitation and community integration, prevention of complications, and education and training of health workers and teams. Timely rehabilitation interventions for Spinal cord injuries and lower limb amputations following the Pakistan, China and Haiti earthquakes resulted in reduction in morbidity and mortality among those with catastrophic injuries.

Methylprednisolone or naloxone treatment after acute spinal cord injury: 1-year follow-up data

1992 ◽  
Vol 76 (1) ◽  
pp. 23-31 ◽  
Author(s):  
Michael B. Bracken ◽  
Mary Jo Shepard ◽  
William F. Collins ◽  
Theodore R. Holford ◽  
David S. Baskin ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Motor Function ◽  
Controlled Trial ◽  
Acute Spinal Cord Injury ◽  
Sensory Function ◽  
Content Type ◽  
Cord Injury ◽  
Multicenter Randomized Controlled Trial

✓ The 1-year follow-up data of a multicenter randomized controlled trial of methylprednisolone (30 mg/kg bolus and 5.4 mg/kg/hr for 23 hours) or naloxone (5.4 mg/kg bolus and 4.0 mg/kg/hr for 23 hours) treatment for acute spinal cord injury are reported and compared with placebo results. In patients treated with methylprednisolone within 8 hours of injury, increased recovery of neurological function was seen at 6 weeks and at 6 months and continued to be observed 1 year after injury. For motor function, this difference was statistically significant (p = 0.030), and was found in patients with total sensory and motor loss in the emergency room (p = 0.019) and in those with some preservation of motor and sensory function (p = 0.024). Naloxone-treated patients did not show significantly greater recovery. Patients treated after 8 hours of injury recovered less motor function if receiving methylprednisolone (p = 0.08) or naloxone (p = 0.10) as compared with those given placebo. Complication and mortality rates were similar in either group of treated patients as compared with the placebo group. The authors conclude that treatment with the study dose of methylprednisolone is indicated for acute spinal cord trauma, but only if it can be started within 8 hours of injury.

The pathophysiological response to spinal cord injury

1974 ◽  
Vol 40 (1) ◽  
pp. 3-33 ◽  
Author(s):  
Jewell L. Osterholm
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Controversial Issues ◽  
Content Type ◽  
Cord Injury ◽  
Injury Research ◽  
Fine Print

✓ In this review of spinal cord injury research, the author has selected contributions which in his opinion best represent modern experimental concepts regarding the mechanism and management of spinal cord injuries. He has placed special emphasis on the controversial issues appropriate to a new, stimulating, and competitive area of research.

Sign in / Sign up

Export Citation Format

Share Document