scholarly journals Methylprednisolone therapy in acute spinal cord injuries

2021 ◽  
Vol 2 (4) ◽  
pp. 409-415
Author(s):  
Slaviša Zagorac
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Paper Analysis ◽  
Late Complications ◽  
Current Understanding ◽  
Neurological Deficits ◽  
Term Therapy ◽  
Pharmacological Agents ◽  
Therapeutic Benefits ◽  
Cord Injury

Spinal cord injuries represent a major challenge in terms of current concepts of treatment. This condition is frequently associated with long term therapy in addition to a greater incidence of early and late complications. The goal of treatment is to alleviate pressure on the spinal cord caused by hematomas or bone fragments, in the shortest time possible. Hence, surgical decompression of the spinal cord is the first line of treatment, in cases where this approach is indicated. Apart from invasive methods, treatment also consists of the use of various pharmacological agents, whose therapeutic goal is to decrease edema and inflammation, especially in the first several days following injury. One of the most commonly administered drugs in such cases is methylprednisolone, however, controversy with regards to the timing of its administration and proper dosing, still exists. This drug has been in use for decades in the treatment of spinal cord injuries with various protocols having been introduced and revised overtime. The aim of this article is to showcase the current understanding of the use of corticosteroids in acute spinal cord injuries. The most significant protocols in use today for the administration of methylprednisolone (National Acute Spinal Cord Injury Studies-NASCIS I, II and III), along with a brief overview of pertinent literature, are discussed in this paper. Analysis of the available data suggests that the use of methylprednisolone in spinal cord injuries is still highly controversial due to the inconclusive relationship between the therapeutic benefits and the risk of side effects. The current understanding is that the use of the drug is justified in the first eight hours following injury, especially in cases involving incomplete neurological deficits, more specifically quadriparesis and paraparesis.

scholarly journals Medical Treatment in Spinal Cord Injury

2021 ◽  
Author(s):  
Halil Can ◽  
Eyüp Cab Savrunlu ◽  
Serdar Kabataş
Keyword(s):  
Spinal Cord ◽  
Large Scale ◽  
Spinal Cord Injuries ◽  
Controlled Clinical Trials ◽  
Pharmacological Agents ◽  
Randomized Controlled Clinical Trials ◽  
Randomized Controlled ◽  
Secondary Damage ◽  
Cord Injury ◽  
Neurological Progression

Spinal cord injuries cause psychological in humans and require expensive care and treatments. In recent years, various pharmacological agents have been tested in acute spinal cord injuries. Prospective randomized controlled clinical trials on a large scale have failed to demonstrate significant neurological progression, in contrast to their success in the laboratory. The search for an effective neuroprotective pharmacological agent to prevent secondary damage in acute spinal cord injuries remains primary goals for basic sciences and clinicians.

Spinal cord concussion

1990 ◽  
Vol 72 (6) ◽  
pp. 894-900 ◽  
Author(s):  
Thomas J. Zwimpfer ◽  
Mark Bernstein
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Spinal Injury ◽  
Cord Compression ◽  
Neurological Deficits ◽  
Content Type ◽  
Young Males ◽  
Cord Injury ◽  
Sensory Disturbances ◽  
Fine Print

✓ The hallmark of concussion injuries of the nervous system is the rapid and complete resolution of neurological deficits. Cerebral concussion has been well studied, both clinically and experimentally. In comparison, spinal cord concussion (SCC) is poorly understood. The clinical and radiological features of 19 SCC injuries in the general population are presented. Spinal cord injuries were classified as concussions if they met three criteria: 1) spinal trauma immediately preceded the onset of neurological deficits; 2) neurological deficits were consistent with spinal cord involvement at the level of injury; and 3) complete neurological recovery occurred within 72 hours after injury. Most cases involved young males, injured during athletics or due to falls. Concussion occurred at the two most unstable spinal regions, 16 involving the cervical spinal and three the thoracolumbar junction. Fifteen cases presented with combined sensorimotor deficits, while four exhibited only sensory disturbances. Many patients showed signs of recovery with the first few hours after injury and most had completely recovered within 24 hours. Only one case involved an unstable spinal injury. There was no evidence of ligamentous instability, spinal stenosis, or canal encroachment in the remaining 18 cases. Two patients, both children, suffered recurrent SCC injuries. No delayed deterioration or permanent cord injuries occurred. Spinal abnormalities that would predispose the spinal cord to a compressive injury were present in only one of the 19 cases. This suggests that, as opposed to direct cord compression, SCC may be the result of an indirect cord injury. Possible mechanisms are discussed.

Pulmonary Complications of Acute Spinal Cord Injuries

Neurosurgery ◽  
1987 ◽  
Vol 21 (2) ◽  
pp. 193-196 ◽  
Author(s):  
David H. Reines ◽  
Robert C. Harris
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Forced Vital Capacity ◽  
Vital Capacity ◽  
Spinal Cord Injuries ◽  
Pulmonary Complications ◽  
Neurological Deficits ◽  
Respiratory Problems ◽  
Cord Injury ◽  
The Mean

Abstract The records of 123 consecutive patients admitted with spinal cord injury were examined for the presence of pulmonary complications. Forty-nine had tetraplegia and 23 had paraplegia; the remainder suffered a variety of neurological deficits. Multiple injuries were encountered in 36 patients. Fifty-three pulmonary complications were noted in 44 (35.7%) patients. The most common problems were atelectasis and pneumonia. There were 22 (18%) deaths. Fourteen deaths were related to pulmonary complications. The mean age of patients who died was 52 ± 13 (SE) compared to 28 ± 12 for survivors. A mean forced vital capacity (FVC) of 1127 ± 410 cc in patients suffering respiratory difficulties compared to a FVC of 1865 ± 85 cc in patients without complications (P < 0.001). Oxygenation (PaO2 90 ± 19 torr) was normal in patients without respiratory problems and was abnormal in patients developing problems (PaO2 76 ± 30 torr; P < 0.05). Twenty patients were treated with a rotating bed. The complication rate of patients on the bed was only 10%. In conclusion, respiratory problems remain a significant cause of morbidity and mortality in spinal cord injury. The forced vital capacity, blood oxygen tension, and age are predictors of pulmonary complications. The use of a multidisciplinary approach and a rotating bed may minimize these problems.

scholarly journals Rat Spinal Cord Injury Experimental Model

2016 ◽  
Vol 60 (2) ◽  
pp. 41-46 ◽  
Author(s):  
I. Šulla ◽  
V. Balik ◽  
J. Petrovičová ◽  
V. Almášiová ◽  
K. Holovská ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Basic Research ◽  
Experimental Models ◽  
Neurological Deficits ◽  
Survival Times ◽  
Cord Injury ◽  
Female Wistar Rats ◽  
Trauma Model

Abstract Spinal cord injuries (SCI) with their tragic consequences belong to the most serious pathological conditions. That is why they have stimulated basic research workers, as well as health care practitioners, to search for an effective treatment for decades. Animal experimental models have been essential in these efforts. We have jointly decided to test and standardize one of the spinal cord injury compression models in rats. Twentythree adult female Wistar rats weighing 250-320 g were utilized. Employing general anaesthesia along with a mixture of sevoflurane with O2, 2 rats (sham controls) had their vertebral arch of either Th8 or Th9 vertebra removed (laminectomy). The other 21 experimental rats with similar laminectomies were divided into 3 subgroups (n = 7) which received compression impact forces of 30, 40 or 50 g (subgroups-1, -2, and -3, respectively) applied on their exposed spinal medulla for 15 minutes. All rats were observed for 28 days after the experimental procedure and their motor functions were assessed by the Basso, Beattie, Bresnahan (BBB) test 6 hours, 7, 21 and 28 days after the simulated SCI. All 23 rats survived the surgical procedures. The control rats were without any neurological deficits. There were, in every experimental subgroup, 1 or 2 rats with extreme BBB scores. So the rats with the maximum and minimum BBB values were excluded. Then, the results acquired in the residual 5 rats in each group were averaged and statistically analysed by the Tukey multiple comparisons test. Statistically significant intersubgroup differences were found at all survival times equal to or longer than 7 post SCI days. The goal of the SCI experiment was to generate a reproducible and reliable, submaximal spinal cord trauma model. The statistical analyses demonstrated that this objective was best achieved in the subgroup-2 with the 40 g compression.

scholarly journals Hyaluronic Acid-Coated Nanoparticles for the Localized Delivery of Methylprednisolone to the Injured Spinal Cord

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Chao Chen ◽  
Xun Sun ◽  
Qiang Yang ◽  
Xinlong Ma
Keyword(s):  
Spinal Cord ◽  
Hyaluronic Acid ◽  
Targeted Delivery ◽  
Spinal Cord Injuries ◽  
Plga Nanoparticles ◽  
Neurological Deficits ◽  
Local Administration ◽  
High Dose ◽  
Cord Injury ◽  
Localized Delivery

Background. The injuries associated with the spinal cord, including trauma, tumor, or disease, may lead irreparable damage leading to limited or loss of mobility, paralysis, and in extreme cases may loss senses. Methylprednisolone (MP) is often used to treat acute spinal cord injuries but suffers with high dose toxicity. The local administration of MP can overcome the neurological deficits associated with its high-dose systemic administration. Method. In the present study, we have designed a targeted delivery system hyaluronic acid- (HA-) coated polyethylenimine- (PEI-) modified poly lactic-co-glycolic acid (PLGA) nanoparticles (HA-MP-PEI-PLGA) for the localized delivery of MP. The PEI-modified PLGA (PEI-PLGA) nanoparticles were prepared and coated electrostatically by HA. The particles were well characterized using DLS and SEM analysis. The efficacy of the particles was compared with unmodified MP-PEI-PLGA nanoparticles in an in vitro and in vivo model. Results. The synthesis of PEI-PLGA was confirmed using FTIR. The HA-MP-PEI-PLGA and MP-PEI-PLGA were of size 163 ± 13   nm and 124 ± 9   nm , respectively. The major difference was observed in zeta potential of the nanoparticles where the charge reversal was observed, which was +22.6 mV and -12.9 mV, respectively, for MP-PEI-PLGA and HA-MP-PEI-PLGA. The percentage encapsulation efficiencies (EE) were calculated to be 71.4 ± 3.76 and 65.4 ± 4.71 . The synthesized nanoparticles showed the sustained release of MP which significantly reduced the proinflammatory cytokines and the lesion in HA-MP-PEI-PLGA-treated rats and enhanced the growth of axons and blood vessels; also, it reduced the production of nitric oxide. Conclusion. The results revealed that local administration of HA-MP-PEI-PLGA enhances their efficiency for effective treatment of spinal cord injury (SCI).

scholarly journals Magnetic resonance imaging in lumbar gunshot wounds: an absolute contraindication?

2014 ◽  
Vol 37 (1) ◽  
pp. E13 ◽  
Author(s):  
Eduardo Martinez-del-Campo ◽  
Leonardo Rangel-Castilla ◽  
Hector Soriano-Baron ◽  
Nicholas Theodore
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Spinal Canal ◽  
English Language ◽  
Spinal Cord Injuries ◽  
Gunshot Wounds ◽  
Neurological Deficits ◽  
Neurological Improvement ◽  
Cord Injury

Object Performance of MR imaging in patients with gunshot wounds at or near the lumbar spinal canal is controversial. The authors reviewed the literature on the use of MR imaging in gunshot wounds to the spine. They discuss the results from in vitro and clinical studies, analyze the physical properties of common projectiles, and evaluate the safety and indications for MR imaging when metallic fragments are located near the spinal canal. Methods A review of the English-language literature was performed. Data from 25 articles were analyzed, including 5 in vitro studies of the interaction between 95 projectiles and the MR system's magnetic fields, and the clinical outcomes in 22 patients with metallic fragments at or near the spinal canal who underwent MR imaging. Results Properties of 95 civilian and military projectiles were analyzed at a magnet strength of 1, 1.5, 3, and 7 T. The most common projectiles were bullets with a core of lead, either with a copper jacket or unjacketed (73 [76.8%] of 95). Steel-containing (core or jacket) projectiles comprised 14.7%. No field interaction was evident in 78 (96.3%) of the 81 nonsteel projectiles. All steel projectiles showed at least positive deflection forces, longitudinal migration, or rotation. Heating of the projectiles was clinically insignificant. Image artifact was significant in all 9 steel bullets tested, but was not significant in 39 (88.6%) of the 44 nonsteel bullets tested. Overall, 22 patients with complete (82%) and incomplete (14%) spinal cord injury secondary to a projectile lodged inside the spinal canal underwent MR imaging. Discomfort and further physical or neurological deficits were not reported by any patient. Two patients with spinal cord injuries underwent MR imaging studies before surgical decompression and had subsequent, significant neurological improvement. Conclusions Metallic implants near or at the spinal canal are a relative contraindication for MR imaging. However, safe MR imaging might be feasible when a projectile's properties and a patient's individualized clinical presentation are considered.

scholarly journals Progress in Understanding Ferroptosis and Its Targeting for Therapeutic Benefits in Traumatic Brain and Spinal Cord Injuries

2021 ◽  
Vol 9 ◽  
Author(s):  
Xinli Hu ◽  
Yu Xu ◽  
Hui Xu ◽  
Chenqiang Jin ◽  
Haojie Zhang ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cell Death ◽  
Nervous System ◽  
Spinal Cord Injuries ◽  
Glutathione Metabolism ◽  
Autonomic Nervous System Dysfunction ◽  
Therapeutic Benefits ◽  
Relevant Effect ◽  
Cord Injury ◽  
Cns Trauma

Acute central nervous system (CNS) trauma, including spinal cord injury (SCI) and traumatic brain injury (TBI), always leads to severe sensory, motor and autonomic nervous system dysfunction due to a series of processes, including cell death, oxidative stress, inflammation, and excitotoxicity. In recent years, ferroptosis was reported to be a type of programmed cell death characterized by the consumption of polyunsaturated fatty acids and the accumulation of membrane lipid peroxides. The processes that induce ferroptosis include iron overload, imbalanced glutathione metabolism and lipid peroxidation. Several studies have indicated a novel association of ferroptosis and acute CNS trauma. The present paper reviews recent studies of the occurrence of ferroptosis, stressing the definition and process of ferroptosis and metabolic pathways related to ferroptosis. Furthermore, a summary of the existing knowledge of the role of ferroptosis in CNS trauma is presented. The aim here is to effectively understand the mechanisms underlying the occurrence of ferroptosis, as well as the relevant effect on the pathophysiological process of CNS trauma, to present a novel perspective and frame of reference for subsequent investigations.

Rehabilitation of spinal cord injuries

2011 ◽  
Author(s):  
B. Gardner
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Late Complications ◽  
Early Care ◽  
Cord Injury ◽  
Almost All ◽  
Fragmentation Of Care

♦ Fragmentation of care is the greatest threat to the treatment of patients with spinal cord injury♦ Level of injury defines disability♦ Early care critical to prevent late complications♦ Tertiary spinal cord injury may occur (e.g. syrinx of the spinal cord)♦ Complications affect almost all body systems directly or indirectly.

Recurrent spinal cord injury without radiographic abnormalities in children

1988 ◽  
Vol 69 (2) ◽  
pp. 177-182 ◽  
Author(s):  
Ian F. Pollack ◽  
Dachling Pang ◽  
Robert Sclabassi
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Soft Tissues ◽  
Spinal Cord Injuries ◽  
Dorsal Column ◽  
Neurological Deficits ◽  
Spinal Instability ◽  
Content Type ◽  
Flexion Extension ◽  
Cord Injury

✓ Spinal cord injury without radiographic abnormality is a well-known entity in the pediatric age group. Agerelated elasticity of the vertebral ligaments as well as immaturity of the osseous structures in the pediatric spine allow momentary subluxation in response to deforming forces. The resultant neurological injuries range from transient dorsal column dysfunction to complete cord transection. Between 1960 and 1985, 42 such injuries were treated at the Children's Hospital of Pittsburgh. Management of these radiographically occult spinal cord injuries consisted of cervical immobilization for 2 months in a hard collar and restriction of contact sports. Recurrent cord injury occurred in eight cases during the 2-month immobilization period. A clearly defined traumatic episode was identified in seven of the eight patients, although in four children the recurrent trauma to the spine was trivial. Five of the children removed their collars briefly before the second injury, and two children incurred reinjury with the hard collar in place. The remaining child was too young for hard-collar immobilization, and recurrent neurological deterioration occurred during sleep. Serial flexion-extension films failed to detect frank instability in any of the eight cases. The children most susceptible to reinjury were those who sustained mild or transient neurological deficits from an initial cord injury and who rapidly resumed normal activities. Radiographically occult spinal instability resulting from the initial injury to the vertebral and paravertebral soft tissues presumably made these children vulnerable to recurrent spinal cord injury, often from otherwise insignificant trauma. During the last 21 months, 12 additional children have been managed with a more stringent protocol combining neck immobilization in a rigid cervical brace for 3 months and restriction of both contact and noncontact sports, together with a major emphasis on patient compliance. With this new protocol, no recurrent cord injuries have been documented.

Impairment Rating and Spinal Cord Injuries: Revisiting the Guides

2010 ◽  
Vol 15 (3) ◽  
pp. 1-7
Author(s):  
Richard T. Katz
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Functional Independence ◽  
Outcome Data ◽  
Multiple Organ ◽  
Loss Of Function ◽  
Sixth Edition ◽  
Organ Systems ◽  
Cord Injury ◽  
Impairment Ratings

Abstract This article addresses some criticisms of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) by comparing previously published outcome data from a group of complete spinal cord injury (SCI) persons with impairment ratings for a corresponding level of injury calculated using the AMA Guides, Sixth Edition. Results of the comparison show that impairment ratings using the sixth edition scale poorly with the level of impairments of activities of daily living (ADL) in SCI patients as assessed by the Functional Independence Measure (FIM) motor scale and the extended FIM motor scale. Because of the combinations of multiple impairments, the AMA Guides potentially overrates the impairment of paraplegics compared with that of quadriplegics. The use and applicability of the Combined Values formula should be further investigated, and complete loss of function of two upper extremities seems consistent with levels of quadriplegia using the SCI model. Some aspects of the AMA Guides contain inconsistencies. The concept of diminishing impairment values is not easily translated between specific losses of function per organ system and “overall” loss of ADLs involving multiple organ systems, and the notion of “catastrophic thresholds” involving multiple organ systems may support the understanding that variations in rating may exist in higher rating cases such as those that involve an SCI.

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