scholarly journals Challenges and management of spine trauma during Covid-19

2021 ◽  
pp. 89-90
Keyword(s):  
Elective Surgery ◽  
Lumbar Fusion ◽  
Rapid Development ◽  
Neurological Deficits ◽  
Significant Shift ◽  
Spine Trauma ◽  
Cord Injury ◽  
Institutional Structures ◽  
Polytrauma Patients ◽  
Management Techniques

The COVID-19 pandemic is the most serious threat to national health systems in a century. The rapid development and spread of the COVID-19 disease necessitated a significant shift in clinical practice and a restructuring of institutional structures. Elective surgery has been drastically reduced in Spinal Surgery Units around the world since the start of the pandemic, and spine trauma management techniques have changed dramatically. All elective treatments, including spinal surgeries, were cancelled due to the virus's highly contagious nature, reduced nosocomial infection, and freed up extra beds for COVID-19 diseases. Emergencies, such as growing neurological deficits or spine instability caused by fractures, infections, or malignancies, could not be postponed. While different considerations should have been made before performing routine spine procedures, the latter was rendered more difficult due to unknown characteristics of the COVID-19 infection. In one study, all patients were polytrauma patients with a higher risk of pneumonia complications due to trauma. The usefulness of corticosteroids in the treatment of spinal cord injury is debated. In the instance of COVID-19 infection, Russell et al. advised not to use corticosteroids. Pneumonia was linked to a 20percent increase in death rate following posterior lumbar fusion surgeries in research by Bohl et al.

Natural Products for the Treatment of Neurodegenerative Diseases

2020 ◽  
Vol 27 (34) ◽  
pp. 5790-5828 ◽  
Author(s):  
Ze Wang ◽  
Chunyang He ◽  
Jing-Shan Shi
Keyword(s):  
Nervous System ◽  
Natural Products ◽  
Neurodegenerative Diseases ◽  
Neuroprotective Effect ◽  
Rapid Development ◽  
New Drugs ◽  
Progressive Degeneration ◽  
Cord Injury ◽  
The Central Nervous System ◽  
And Function

Neurodegenerative diseases are a heterogeneous group of disorders characterized by the progressive degeneration of the structure and function of the central nervous system or peripheral nervous system. Alzheimer's Disease (AD), Parkinson's Disease (PD) and Spinal Cord Injury (SCI) are the common neurodegenerative diseases, which typically occur in people over the age of 60. With the rapid development of an aged society, over 60 million people worldwide are suffering from these uncurable diseases. Therefore, the search for new drugs and therapeutic methods has become an increasingly important research topic. Natural products especially those from the Traditional Chinese Medicines (TCMs), are the most important sources of drugs, and have received extensive interest among pharmacist. In this review, in order to facilitate further chemical modification of those useful natural products by pharmacists, we will bring together recent studies in single natural compound from TCMs with neuroprotective effect.

Rehabilitation of the canine patient following spinal cord injury: a practical guide

2021 ◽  
Vol 26 (1) ◽  
pp. 1-6
Author(s):  
Cheryl Corral
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Injury ◽  
Neurological Deficits ◽  
Practical Guide ◽  
Cord Injury ◽  
Physical Therapies

This article forms part of a series exploring the rehabilitation of the canine shoulder, elbow, back, hip and stifle following injury or disease. Discussed here are different rehabilitation techniques used to address neurological deficits, pain and weakness following spinal injury, including physical therapies, electrotherapies and acupuncture.

scholarly journals Local Serpin Treatment via Chitosan-Collagen Hydrogel after Spinal Cord Injury Reduces Tissue Damage and Improves Neurologic Function

2020 ◽  
Vol 9 (4) ◽  
pp. 1221 ◽  
Author(s):  
Jacek M. Kwiecien ◽  
Liqiang Zhang ◽  
Jordan R. Yaron ◽  
Lauren N. Schutz ◽  
Christian J. Kwiecien-Delaney ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Tissue Damage ◽  
Low Dose ◽  
Dorsal Column ◽  
Neurological Deficits ◽  
Sustained Delivery ◽  
Post Surgery ◽  
Cord Injury ◽  
Anti Inflammatory

Spinal cord injury (SCI) results in massive secondary damage characterized by a prolonged inflammation with phagocytic macrophage invasion and tissue destruction. In prior work, sustained subdural infusion of anti-inflammatory compounds reduced neurological deficits and reduced pro-inflammatory cell invasion at the site of injury leading to improved outcomes. We hypothesized that implantation of a hydrogel loaded with an immune modulating biologic drug, Serp-1, for sustained delivery after crush-induced SCI would have an effective anti-inflammatory and neuroprotective effect. Rats with dorsal column SCI crush injury, implanted with physical chitosan-collagen hydrogels (CCH) had severe granulomatous infiltration at the site of the dorsal column injury, which accumulated excess edema at 28 days post-surgery. More pronounced neuroprotective changes were observed with high dose (100 µg/50 µL) Serp-1 CCH implanted rats, but not with low dose (10 µg/50 µL) Serp-1 CCH. Rats treated with Serp-1 CCH implants also had improved motor function up to 20 days with recovery of neurological deficits attributed to inhibition of inflammation-associated tissue damage. In contrast, prolonged low dose Serp-1 infusion with chitosan did not improve recovery. Intralesional implantation of hydrogel for sustained delivery of the Serp-1 immune modulating biologic offers a neuroprotective treatment of acute SCI.

scholarly journals Determinants of Timing of Presentation of Neurotrauma Patients to a Neurosurgical Center in a Developing Country

2018 ◽  
Vol 09 (04) ◽  
pp. 545-550 ◽  
Author(s):  
Toluyemi Adefolarin Malomo ◽  
Toyin Ayofe Oyemolade ◽  
Amos Olufemi Adeleye
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Late Presentation ◽  
Neurological Deficits ◽  
Delayed Presentation ◽  
Long Distance ◽  
College Hospital ◽  
Cross Sectional ◽  
Initial Care ◽  
Cord Injury

ABSTRACT Background: A major goal in neurotrauma management is the prevention of secondary neuronal injuries. This goal is time bound as neurological deficits once established are usually irreversible. Late presentation is the norm in most neurotrauma patients in developing countries. Aims: The aim of the study was to review the timing of presentation of neurotrauma patients and the possible causes of their late presentation for neurosurgical care in our practice. Methods: A cross-sectional study of a 4-month prospective database of neurotrauma patients presenting to the University College Hospital, Ibadan, was done. The participants’ biodata, injury characteristics, initial-care details before referral, and information on timing and causes of delay were analyzed. Results: The study subjects included 111 patients, 80.2% (89/111) were males, and 52.8% aged 21–40 years. Head injury (HI), spinal cord injury (SCI), and combined HI and SCI occurred, respectively, in 80.2%, 14.4%, and 5.4%. Road accidents followed by falls were seen in 73.9% and 14.4% (16), respectively. Just 46.8% (52/111) cases presented within 12 h of injury and only 37 (33.3%) within 4 h. Majority, 83.8% (93/111) were referrals from primary care. These referrals were delayed in 81.7% (76/93) of these. The referring health facilities were located intracity with our center in 54%. Other causes of delayed presentation of these study participants included long-distance travel to our center, lack of funds, or a combination of the above factors. Eighty-nine patients (80.2%) were brought in by family members and the remaining minority by passers-by and road safety personnel. Conclusions: Delayed referral from primary care features prominently in timing of presentation of neurotrauma patients in Nigeria. There is a need for collaboration as well as continuing medical education between the neurotrauma specialists and primary care physicians.

Editorial

2004 ◽  
Vol 3 (2) ◽  
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Bacterial Meningitis ◽  
Medical Staff ◽  
Case Reports ◽  
Rapid Development ◽  
Working Party ◽  
Significant Shift ◽  
Multiple Choice Questions ◽  
Acute Medicine ◽  
Junior Staff ◽  
The Uk

Over the past three years it has become apparent to me that referring to ‘current affairs’ in these columns can be a mistake, serving only to highlight inevitable printing delays. By the time this edition arrives on your doormat Euro 2004, ‘Big Brother’ and the early summer heat wave will be nothing but a distant memory. However the ‘recent’ publication of the Royal College of Physicians document ‘Acute Medicine – making it work for patients’ cannot be allowed to pass without a mention. This report represents a significant shift in the position of the College in relation to Acute Medicine since the previous working party reported its findings in 2000. The value of consultants specialising in Acute Medicine is now clearly recognised and supported – every trust should now have one, with the minimum figure of three per hospital being proposed by 2008. Whether this is achievable will depend on the rapid development of training schemes across the UK, as well as the generation of enthusiasm for the specialty amongst junior staff. The number of applicants for our Wessex programme indicates no shortage of the latter. Although developing a training scheme takes a lot of hard work, it is vital that those already working in the specialty make this a high priority. We have already seen benefits from the appointment of high quality middle grade staff and are looking forward to a ‘flood’ of future applicants for local consultant posts, 4 years from now. This edition comprises four more important review papers on aspects of acute medicine, along with the first in our ‘Controversies in acute medicine’ series. The latter was designed to try to stir up some correspondence, for future publication. The confusion over oxygen delivery in the acute setting seems to reign fairly widely amongst junior, and indeed some more senior medical staff. Hopefully Dr Cooper’s well-written paper will serve to dismiss some of the misconceptions in this area. Our reviews cover relatively uncommon, but nonetheless important aspects of acute medicine. Tuberculosis and HIV are both on the increase in the UK. The success of anti-retroviral therapy will undoubtedly lead HIVrelated illness to be a significant part of our practice over the next decade. An understanding of the range of conditions specific to this group of immunocompromised patients is therefore crucial for physicians involved in the acute take. Hypoglycaemia and suspected bacterial meningitis are both conditions which require immediate action by medical staff. Both of these reviews comprehensively cover their respective topics with a combination of well written text, illustrations tables and algorithms. Dr Hartman highlights recent evidence supporting the use of dexamethosone in bacterial meningitis and re-iterates some of the points made in an earlier edition regarding the use (and abuse) of CT scanning prior to lumbar puncture. For a change we have no case reports this time, although Dr Macdonald’s audit of the innovative review clinic in the Emergency Assessment Area of Heartlands hospital provides a worthy substitute. Submission of similar articles in future would be most welcome. Once again, a reminder that multiple choice questions are for self assessment and ‘personal’ CPD only; I hope you will find this edition helpful in your clinical practice.

scholarly journals Nogo receptor decoy promotes recovery and corticospinal growth in non-human primate spinal cord injury

Brain ◽  
2020 ◽  
Vol 143 (6) ◽  
pp. 1697-1713 ◽  
Author(s):  
Xingxing Wang ◽  
Tianna Zhou ◽  
George D Maynard ◽  
Pramod S Terse ◽  
William B Cafferty ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Recovery Of Function ◽  
Neurological Deficits ◽  
Vehicle Group ◽  
Post Injury ◽  
Nogo Receptor ◽  
Human Dose ◽  
Cord Injury ◽  
Human Primate

Abstract After CNS trauma such as spinal cord injury, the ability of surviving neural elements to sprout axons, reorganize neural networks and support recovery of function is severely restricted, contributing to chronic neurological deficits. Among limitations on neural recovery are myelin-associated inhibitors functioning as ligands for neuronal Nogo receptor 1 (NgR1). A soluble decoy (NgR1-Fc, AXER-204) blocks these ligands and provides a means to promote recovery of function in multiple preclinical rodent models of spinal cord injury. However, the safety and efficacy of this reagent in non-human primate spinal cord injury and its toxicological profile have not been described. Here, we provide evidence that chronic intrathecal and intravenous administration of NgR1-Fc to cynomolgus monkey and to rat are without evident toxicity at doses of 20 mg and greater every other day (≥2.0 mg/kg/day), and far greater than the projected human dose. Adult female African green monkeys underwent right C5/6 lateral hemisection with evidence of persistent disuse of the right forelimb during feeding and right hindlimb during locomotion. At 1 month post-injury, the animals were randomized to treatment with vehicle (n = 6) or 0.10–0.17 mg/kg/day of NgR1-Fc (n = 8) delivered via intrathecal lumbar catheter and osmotic minipump for 4 months. One animal was removed from the study because of surgical complications of the catheter, but no treatment-related adverse events were noted in either group. Animal behaviour was evaluated at 6–7 months post-injury, i.e. 1–2 months after treatment cessation. The use of the impaired forelimb during spontaneous feeding and the impaired hindlimb during locomotion were both significantly greater in the treatment group. Tissue collected at 7–12 months post-injury showed no significant differences in lesion size, fibrotic scar, gliosis or neuroinflammation between groups. Serotoninergic raphespinal fibres below the lesion showed no deficit, with equal density on the lesioned and intact side below the level of the injury in both groups. Corticospinal axons traced from biotin-dextran-amine injections in the left motor cortex were equally labelled across groups and reduced caudal to the injury. The NgR1-Fc group tissue exhibited a significant 2–3-fold increased corticospinal axon density in the cervical cord below the level of the injury relative to the vehicle group. The data show that NgR1-Fc does not have preclinical toxicological issues in healthy animals or safety concerns in spinal cord injury animals. Thus, it presents as a potential therapeutic for spinal cord injury with evidence for behavioural improvement and growth of injured pathways in non-human primate spinal cord injury.

Evaluation of experimental spinal cord injury using cortical evoked potentials

1973 ◽  
Vol 39 (1) ◽  
pp. 75-81 ◽  
Author(s):  
Stephen H. Martin ◽  
James R. Bloedel
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cortical Response ◽  
Neurological Deficits ◽  
Cystic Degeneration ◽  
Post Injury ◽  
Content Type ◽  
Cord Injury ◽  
Cortical Responses ◽  
Control Response

✓ Experiments were performed to determine if changes in cortical evoked responses could be used to predict the extent of the neurological deficits following spinal cord injury by sudden inflation of a Fogarty balloon in the epidural space cephalad to a laminectomy. The cortical responses to stimulation of the posterior tibial nerve were recorded over the sigmoid gyrus at various times following the lesion and compared with the control response. Severe, irreversible neurological deficits occurred in cats in which the cortical response either could not be evoked immediately after injury or disappeared rapidly during this period. At the end of at least 6 weeks following injury, all of these animals were paraplegic and showed severe cystic degeneration of the spinal cord. In animals in which the post-injury cortical response did not completely disappear, only mild changes were observed in a spinal cord 6 weeks following injury. This technique may be helpful in ascertaining the severity and irreversibility of a traumatic spinal cord lesion; because the technique is simple, the method may prove helpful in the clinical management of patients with spinal cord injury.

scholarly journals Lumbar stenosis: indications for fusion with and without instrumentation

1997 ◽  
Vol 3 (2) ◽  
pp. E6 ◽  
Author(s):  
Paul W. Detwiler ◽  
Frederick F. Marciano ◽  
Randall W. Porter ◽  
Volker K. H. Sonntag
Keyword(s):  
Facet Joint ◽  
Dynamic Instability ◽  
Lumbar Fusion ◽  
Rapid Development ◽  
Degenerative Spondylolisthesis ◽  
Lumbar Stenosis ◽  
Disc Disease ◽  
Diagnostic Categories ◽  
Number Of Factors ◽  
Failed Back Surgery

Although the efficacy of posterior decompression for symptomatic lumbar stenosis that is recalcitrant to conservative therapy is well proven, uniform agreement on the need for simultaneous arthrodesis is lacking. The variability in the rate of lumbar fusion with and without instrumentation has been attributed to a number of factors: advances in surgical technique; rapid development of instrumentation; radiographic advances in the diagnosis of disease entities of the lumbar spine; evolution in our understanding of bone healing; improved pre- and postoperative care; aggressive rehabilitation; patient compensation; hospital and surgeon reimbursement; better education of residents, fellows, and practicing neurosurgeons; and, most important, the lack of clear indications based on defined diagnostic categories. Based on review of the literature and their experience at the Barrow Neurological Institute, the authors have attempted to define indications for lumbar fusion with or without instrumentation based on defined diagnostic categories. Clear indications for fusion include trauma, tumor, or infection with two- or three-column injury, iatrogenic instability, and isthmic spondylolisthesis. Relative indications for fusion include degenerative spondylolisthesis, radiographically proven dynamic instability with pain or neurological findings, adult scoliosis, and mechanical back pain. Fusion is rarely indicated with discectomy, abnormal radiographs without appropriate findings (such as degenerative disc disease), facet joint syndrome, failed back surgery, or stable spinal stenosis.

scholarly journals Nogo-A targeted therapy promotes vascular repair and functional recovery following stroke

2019 ◽  
Vol 116 (28) ◽  
pp. 14270-14279 ◽  
Author(s):  
Ruslan Rust ◽  
Lisa Grönnert ◽  
Christina Gantner ◽  
Alinda Enzler ◽  
Geertje Mulders ◽  
...  
Keyword(s):  
Functional Recovery ◽  
Therapeutic Angiogenesis ◽  
Brain Regions ◽  
Neurological Deficits ◽  
Cerebral Stroke ◽  
Neural Repair ◽  
Functional Deficits ◽  
Cord Injury ◽  
Guidance Molecules ◽  
The Central Nervous System

Stroke is a major cause of serious disability due to the brain’s limited capacity to regenerate damaged tissue and neuronal circuits. After ischemic injury, a multiphasic degenerative and inflammatory response is coupled with severely restricted vascular and neuronal repair, resulting in permanent functional deficits. Although clinical evidence indicates that revascularization of the ischemic brain regions is crucial for functional recovery, no therapeutics that promote angiogenesis after cerebral stroke are currently available. Besides vascular growth factors, guidance molecules have been identified to regulate aspects of angiogenesis in the central nervous system (CNS) and may provide targets for therapeutic angiogenesis. In this study, we demonstrate that genetic deletion of the neurite outgrowth inhibitor Nogo-A or one of its corresponding receptors, S1PR2, improves vascular sprouting and repair and reduces neurological deficits after cerebral ischemia in mice. These findings were reproduced in a therapeutic approach using intrathecal anti–Nogo-A antibodies; such a therapy is currently in clinical testing for spinal cord injury. These results provide a basis for a therapeutic blockage of inhibitory guidance molecules to improve vascular and neural repair after ischemic CNS injuries.

scholarly journals Neurological recovery after surgical intervention of a complete spinal cord injury secondary to a chronic untreated odontoid neck fracture: a lesson in patient prognostication

2020 ◽  
Vol 13 (1) ◽  
pp. e233077
Author(s):  
Patricio III Espinoza Dumlao ◽  
Samuel Grozman
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Injury ◽  
Neurological Deficits ◽  
Posterior Decompression ◽  
Clear Cut ◽  
Cord Injury ◽  
Neck Fracture ◽  
Complete Spinal Cord Injury

Odontoid fractures are injuries that can either be benign or devastatingly progress to quadriplegia and significant morbidity and mortality. Management is not clear cut for patients who already present late and with severe neurological deficits. We present a case of a type 2 odontoid fracture with associated complete spinal cord injury (American Spinal Injury Association A) initially untreated for 3 months but was subsequently managed with posterior decompression, instrumentation and occipitocervical fusion. The patient fully recovered all deficits and is independent of activities of daily living.

Sign in / Sign up

Export Citation Format

Share Document