scholarly journals Management of Acute Traumatic Spinal Cord Injury: A Review of the Literature

2021 ◽  
Vol 8 ◽  
Author(s):  
Timothy Y. Wang ◽  
Christine Park ◽  
Hanci Zhang ◽  
Shervin Rahimpour ◽  
Kelly R. Murphy ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Injury ◽  
Optimal Recovery ◽  
Neurological Dysfunction ◽  
Traumatic Spinal Cord Injury ◽  
Term Care ◽  
Secondary Damage ◽  
Severity Of Injury ◽  
Cord Injury

Traumatic spinal cord injury (TSCI) is a debilitating disease that poses significant functional and economic burden on both the individual and societal levels. Prognosis is dependent on the extent of the spinal injury and the severity of neurological dysfunction. If not treated rapidly, patients with TSCI can suffer further secondary damage and experience escalating disability and complications. It is important to quickly assess the patient to identify the location and severity of injury to make a decision to pursue a surgical and/or conservative management. However, there are many conditions that factor into the management of TSCI patients, ranging from the initial presentation of the patient to long-term care for optimal recovery. Here, we provide a comprehensive review of the etiologies of spinal cord injury and the complications that may arise, and present an algorithm to aid in the management of TSCI.

Influence of severity and level of injury on the occurrence of complications during the subacute and chronic stage of traumatic spinal cord injury: a systematic review

2021 ◽  
pp. 1-21
Author(s):  
Charlotte Y. Adegeest ◽  
Jort A. N. van Gent ◽  
Janneke M. Stolwijk-Swüste ◽  
Marcel W. M. Post ◽  
William P. Vandertop ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Injury ◽  
Chronic Phase ◽  
Autonomic Dysreflexia ◽  
Traumatic Spinal Cord Injury ◽  
Chronic Stage ◽  
Increased Risk ◽  
Cord Injury ◽  
Meta Analyses

OBJECTIVE Secondary health conditions (SHCs) are long-term complications that frequently occur due to traumatic spinal cord injury (tSCI) and can negatively affect quality of life in this patient population. This study provides an overview of the associations between the severity and level of injury and the occurrence of SHCs in tSCI. METHODS A systematic search was conducted in PubMed and Embase that retrieved 44 studies on the influence of severity and/or level of injury on the occurrence of SHCs in the subacute and chronic phase of tSCI (from 3 months after trauma). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. RESULTS In the majority of studies, patients with motor-complete tSCI (American Spinal Injury Association [ASIA] Impairment Scale [AIS] grade A or B) had a significantly increased occurrence of SHCs in comparison to patients with motor-incomplete tSCI (AIS grade C or D), such as respiratory and urogenital complications, musculoskeletal disorders, pressure ulcers, and autonomic dysreflexia. In contrast, an increased prevalence of pain was seen in patients with motor-incomplete injuries. In addition, higher rates of pulmonary infections, spasticity, and autonomic dysreflexia were observed in patients with tetraplegia. Patients with paraplegia more commonly suffered from hypertension, venous thromboembolism, and pain. CONCLUSIONS This review suggests that patients with a motor-complete tSCI have an increased risk of developing SHCs during the subacute and chronic stage of tSCI in comparison with patients with motor-incomplete tSCI. Future studies should examine whether systematic monitoring during rehabilitation and the subacute and chronic phase in patients with motor-complete tSCI could lead to early detection and potential prevention of SHCs in this population.

scholarly journals Selenium-Binding Protein 1 (SELENBP1) as Biomarker for Adverse Clinical Outcome After Traumatic Spinal Cord Injury

2021 ◽  
Vol 15 ◽  
Author(s):  
Julian Seelig ◽  
Raban Arved Heller ◽  
Patrick Haubruck ◽  
Qian Sun ◽  
Jochen Georg Klingenberg ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Injury ◽  
Cell Damage ◽  
Cell Activity ◽  
Mechanical Trauma ◽  
Specific Cell ◽  
Traumatic Spinal Cord Injury ◽  
Cord Injury ◽  
Sensory Functions

Graphical AbstractThe pathophysiology of traumatic spinal cord injury (TSCI) can be divided into two major phases. (A) The mechanical trauma is followed within minutes by a secondary phase consisting of local complex and intertwined acute responses, intercellular signaling and cell activity regulating pathways. Inflammatory processes, oxidative stress and hypoxia, leading to cell damage and death, and specific cell contents are released into the circulation (B). The motor and sensory deficits upon TSCI are assessed by using the American Spinal Injury Association (ASIA) impairment scale (AIS), ranging from AIS A as a complete absence of any motor and sensory functions under the lesion site, to AIS E with complete preservation of motor and sensory functions. (C) The concentrations of serum SELENBP1 were elevated in patients classified as AIS A as compared to less severely affected patients classified as AIS B, C or D. A cut-off was deduced [(SELENBP1) > 30.2 μg/L], reliably predicting whether a patient belongs to the group showing neurological recovery (G1) or not (G0) within 3 months after the trauma. The figure was created by using https://biorender.com.

scholarly journals Epidemiological Characteristics of Traumatic Spinal Cord Injury in Shaanxi, China

2021 ◽  
Author(s):  
Liang Yan ◽  
Dong Wang ◽  
Jinpeng Du ◽  
Dingjun Hao ◽  
Baorong He ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Medical Records ◽  
Shaanxi Province ◽  
Traumatic Spinal Cord Injury ◽  
Diagnostic Code ◽  
Female Ratio ◽  
Severity Of Injury ◽  
Cord Injury ◽  
Epidemiological Characteristics

Abstract Study Design. A hospital-based retrospective epidemiological study.Summary of Background Data. TSCI is a highly disabling and deadly injury. Currently, there is little information regarding the epidemiological characteristics for TSCI in Shaanxi.Objective: To describe the demographic and epidemiological characteristics of patients with traumatic spinal cord injury (TSCI) in Shaanxi to help health-related institutions formulate corresponding measures.Methods. We retrospectively reviewed the medical records of the spine centers or orthopedic centers of the four cities in Shaanxi province according to the International Classification of Disease Version 10 (ICD-10) and diagnostic code of TSCI. Variables included gender, age, medical insurance, etiology, occupation, time of injury, level of injury, and severity of injury, multiple injury, treatment, and so on.Results: The study included the medical records of 694 patients with TSCI in 2018. The mean age of patients with TSCI was 48.4±14.9 years, and the male/female ratio was 3.45:1. The major causes of TSCI were high falls (40.2%) and low falls (26.7%). The most common injury site was the cervical spinal cord, accounting for 48.7%. The highest proportion of severity of injury was ASIA Grade D (37.8%). In addition, 74.6% of the patients had spinal fractures, the chest (38.0%) accounted for the highest proportion of all TSCI patients. Furthermore, 27.8% of the patients experienced clinical complications. 530 (76.4%) patients underwent surgery, 323 (46.5%) patients underwent inpatient rehabilitation.Conclusion: There are specific epidemiological characteristics of TSCI patients in Shaanxi, and preventive measures are suggested to be based on the characteristics of the different types of patients with TSCI and focused on high-risk groups.

scholarly journals Clinical Characteristics and Challenges of Management of Traumatic Spinal Cord Injury in a Trauma Center of a Developing Country

2019 ◽  
Vol 10 (03) ◽  
pp. 393-399
Author(s):  
Ayodeji Salman Yusuf ◽  
Muhammad Raji Mahmud ◽  
Dumura Jeneral Alfin ◽  
Samue Isa Gana ◽  
Samaila Timothy ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Trauma Center ◽  
Spinal Injury ◽  
Cervical Spinal Cord ◽  
Prehospital Care ◽  
Insurance Coverage ◽  
Traumatic Spinal Cord Injury ◽  
Optimal Care ◽  
Cord Injury

Abstract Background Traumatic spinal cord injury (TSCI) is a major burden in trauma care worldwide. Most victims are young, and the injury results in economic loss and psychological and social burden on the individual and the society. The outcome depends on the severity of primary spinal cord injury, interventions to prevent secondary insults to the damaged cord, and access to a specialized care. The lack of standard prehospital care and dedicated facilities for spine care coupled with challenges of inadequate health insurance coverage impact negatively on the outcome of care in patients with spinal cord injury in our practice. Objectives This study was performed to determine the clinical profile of patients with TSCI and to highlight the factors that determine the early outcome in a resource-constrained trauma center. Materials and Methods  This study was a retrospective review of trauma registry and medical records of all the patients with acute TSCI at the National Trauma Center Abuja from September 2014 to December 2016. Results A total of 133 patients with TSCI were studied. Most of these patients were young men with a mean age of 36 years. Most injury (72.2%) occurred following motor vehicular crash affecting mainly the cervical spinal cord (62.0%). None of the patients received standard prehospital care. Only 41.4% of the patients were transported to the hospital in an ambulance. About half (52.6%) of the patients suffered complete spinal cord injury (the American Spinal Injury Association [ASIA] A), and pressure ulcer was the most common complication (23.3%). Only 42% of the patients that needed surgical intervention were operated, mainly due to the inability to pay for the service. The ASIA grade on admission was the most significant determinant factor of morbidity and mortality. Conclusion Optimal care of patients with TSCI was hindered by inadequate facilities and economic constraints.

scholarly journals The effects of early or direct admission to a specialised spinal injury unit on outcomes after acute traumatic spinal cord injury

Spinal Cord ◽  
2016 ◽  
Vol 55 (5) ◽  
pp. 518-524 ◽  
Author(s):  
M M Maharaj ◽  
R E Stanford ◽  
B B Lee ◽  
R J Mobbs ◽  
O Marial ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Injury ◽  
Traumatic Spinal Cord Injury ◽  
Cord Injury ◽  
Direct Admission

scholarly journals Non-traumatic spinal cord injury: what is the ideal setting for rehabilitation?

2006 ◽  
Vol 30 (3) ◽  
pp. 353 ◽  
Author(s):  
Peter W New
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Response Rate ◽  
Environmental Control ◽  
Spinal Injury ◽  
Inpatient Rehabilitation ◽  
Traumatic Spinal Cord Injury ◽  
Neurological Rehabilitation ◽  
Rehabilitation Team ◽  
Cord Injury

Objective: To survey rehabilitation physicians about management of patients with non-traumatic spinal cord injury (NTSCI). Methods: Postal and email survey of Australian physicians treating adult inpatients in neurological rehabilitation or Spinal Injury Units (SIUs). 59/69 returned surveys met inclusion criteria. 75% (44) of respondents were from neurological rehabilitation units (response rate 72%) and 25% (15) were from SIUs (response rate 94%). Outcomes were: incidence of NTSCI, opinion regarding ideal setting for NTSCI inpatient rehabilitation, and availability of key services for NTSCI patients in neurological rehabilitation units. Results: Estimated incidence of NTSCI was 26/million adults/year. 60% of NTSCI patients were managed in general neurological rehabilitation units. The majority of respondents (85% (50/59); 95% CI, 73%?92%) believed that the most appropriate setting for NTSCI rehabilitation was either an SIU or a neurological team that specialises in NTSCI patients. Neurological rehabilitation units offered NTSCI patients the following services: education regarding coping with NTSCI and preventing complications (55% [18/33]); specialised wheelchair and seating prescription (85% [28/33]); Environmental Control Unit training (36% [12/33]); and bladder training (97% [32/33]). Conclusions: The most appropriate setting for rehabilitation of NTSCI patients is either a dedicated SIU or a neurological rehabilitation team that specialises in NTSCI. The organisation of inpatient rehabilitation services for NTSCI patients in Australia should be improved.

scholarly journals P.220 Mechanism of injury is associated with neurological outcomes in cervical sensorimotor complete traumatic spinal cord injury

2021 ◽  
Vol 48 (s3) ◽  
pp. S83-S83
Author(s):  
AB Bak ◽  
A Moghaddamjou ◽  
M Fehlings
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Injury ◽  
Significant Proportion ◽  
Sports Injury ◽  
Neurological Recovery ◽  
Traumatic Spinal Cord Injury ◽  
Significant Heterogeneity ◽  
Mechanism Of Injury ◽  
Cord Injury

Background: There is significant heterogeneity in neurological recovery after complete (ASIA A) traumatic spinal cord injury (tSCI). Neurological recovery is often associated with a conversion to a higher letter grade of the American Spinal Injury Association’s impairment scale (ASIA). The mechanism of injury (MOI) may play a significant role in the primary injury and should be considered for greater precision in care. Methods: We isolated ASIA A cervical tSCI patients from three multicenter prospective randomized controlled trials (NACTN, STASCIS, Sygen). Chi-square test with pairwise comparisons with Bonferroni corrections was performed to compare the proportion of ASIA A patients that converted to a higher ASIA grade between different MOI. Results: We identified 486 complete cervical tSCI patients. For patients who developed tSCI as a result of a fall, a significant proportion converted to a higher ASIA grade by 52 weeks (p = 0.009). For patients who developed tSCI as a result of a sports injury, a significantly smaller proportion did not convert to a higher ASIA grade compared to those that converted (p = 0.034). Conclusions: Due to the difference in outcomes, tSCI patients should be treated differently depending on their mechanism of injury.

scholarly journals Long-Term Survival and Causes of Death in Patients below the Age of 60 with Traumatic Spinal Cord Injury in Germany

2021 ◽  
Vol 11 (1) ◽  
pp. 26
Author(s):  
Roland Thietje ◽  
Birgitt Kowald ◽  
Ralf Böthig ◽  
Arndt P. Schulz ◽  
Markus Northmann ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Bladder Cancer ◽  
Life Expectancy ◽  
Causes Of Death ◽  
Traumatic Spinal Cord Injury ◽  
Term Survival ◽  
Age Related ◽  
Severity Of Injury ◽  
Cord Injury

To study the mortality, cause and risk indicators of death in German patients with traumatic spinal cord injury, patients with traumatic spinal cord injury admitted to Berufsgenossenschaftliches Trauma Hospital Hamburg between 1 January 1997 and 31 December 2018, aged between 16 and 60 with a minimal survival of one year after injury, were included. Further criteria were the absence of life-limiting comorbidities at the time of injury. 223 deceased patients with traumatic spinal cord injury were identified, investigated on and partly compared to the surviving subjects. We aimed to discover specific complications that were related to Spinal Cord Injury and responsible for a possibly limited life expectancy. Data collection was performed during in- and outpatient treatment. A statistical analysis was performed to compare groups. The post-injury life expectancy was 25.0 years with a significant correlation regarding the level of lesion and severity of injury. The leading causes of death were cardiovascular diseases and pneumonia. Bladder cancer was the most common fatal malignant tumor. The life expectancy of patients suffering from traumatic spinal cord injury is limited. The longer a patient survives after injury and the lower the level of lesion, the more likely an age-related cause of death becomes. Bladder cancer is significantly more frequent when compared to the overall distribution of tumor diseases in Germany.

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