Spinal Cord Injuries in Emergency Medicine

Spinal cord injury is a serious medical disorder that frequently leads in significant morbidity and permanent impairment. Direct damage to the spinal cord or compression owing to broken vertebrae or masses such as epidural hematomas or abscesses are the most common causes of spinal cord injury. When examining a blunt trauma victim, medical professionals are taught to presume the patient has a spinal column damage unless it is proven otherwise. The early examination of a patient with a suspected cervical spinal injury in the emergency department (ED) is no different than that of any other trauma patient. The ABCs, or airway, breathing, and circulation, procedures are being taken into consideration. In acute spinal cord damage, hypotension can be hemorrhagic or neurogenic. Because of the high prevalence of concomitant injuries and vital sign confusion in acute spinal cord injury, a thorough search for hidden sources of bleeding is required. Surgical removal of bone fragments, foreign objects, herniated discs, or broken vertebrae that appear to be compressing the spine is frequently required. In order to avoid future discomfort or deformity, surgery may be required to stabilize the spine. In this review we’ll be looking at spinal cord injury, it’s diagnosis and treatment.

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SOME ASPECTS OF PEDIATRIC SPINAL CORD INJURY

Hirurgiâ pozvonočnika ◽

10.14531/ss2005.4.15-19 ◽

2005 ◽

pp. 015-019

Author(s):

Igor Ivanovich Larkin ◽

Valery Ivanovich Larkin

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Spinal Cord Injuries ◽

Spinal Injury ◽

Radiological Diagnostics ◽

Cord Injury ◽

Pediatric Spinal Cord Injury ◽

Mri Changes

Objective. To analyse the possibility of diagnostics improvement in children with spinal cord injuries. Material and Methods. The observations of 147 cases of various spinal cord injuries in children at the age of 11 months to 15 years have been analyzed. Causes of trauma, age peculiarities of spinal injury manifestations, and difficulties of clinical and radiological diagnostics are discussed. Results. Most cases of spinal cord injury in children could be revealed and adequately managed at a prehospital stage. It should be noted that the spine lesion and MRI changes do not always accompany spinal cord injury in children. This observation must be taken into account while making diagnosis. Conclusion. Electromyography is an important examination confirming spinal cord injury without radiographic abnormalities (SCIWORA syndrome) in children.

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A study of burden of care and its correlates among family members supporting relatives and loved ones with traumatic spinal cord injuries

Clinical Rehabilitation ◽

10.1177/0269215517709330 ◽

2017 ◽

Vol 31 (7) ◽

pp. 948-956 ◽

Cited By ~ 7

Author(s):

Carmina Castellano-Tejedor ◽

Pilar Lusilla-Palacios

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Life Satisfaction ◽

Spinal Cord Injuries ◽

Spinal Injury ◽

Burden Of Care ◽

Zarit Burden Interview ◽

Resilience Scale ◽

Cord Injury ◽

The Future

Objective: To understand and describe in a sample of caregivers of persons with spinal cord injury, their burden of care, resilience and life satisfaction and to explore the relationship between these variables. Design: Cross-sectional design. Setting: One Spinal Cord Injury Acute Inpatient Unit from a general hospital. Subjects: Seventy-five relatives of persons with spinal cord injuries (84% women) with a mean age of 48.55 ( SD = 12.55) years. Interventions: None. Measures: Demographics (neurological loss and severity according to the American Spinal Injury Association criteria), the Zarit Burden Interview, the Resilience Scale and the Life Satisfaction Checklist. Results: All caregivers experienced feelings of different intensities of burden (52% mild-to-moderate, 43% moderate-to-severe and 5% severe), and none of them expressed little or no burden at the assessment moment. Caregivers’ main worries were “dependence” and “the future of the injured.” Resilience was medium-to-high (mean = 141.93, SD = 23.44) for the whole sample with just a minority of them revealing low (15%) or very low resilience (7%). The highest scores were obtained in relation to “caregivers’ independence” and “meaning of their lives.” Life satisfaction scores were medium-to-high (mean = 36.6, SD = 6). These scores were not related to demographics or the severity of the injury. Zarit Burden Interview scores were negatively correlated to Resilience Scale ( r = −.370, P = .001) and Life Satisfaction Checklist scores ( r = −.412, P < .001). Conclusion: More resilient and satisfied caregivers experienced lower burden. Burden is moderate-to-high and mainly related to uncertainty about the future, caregivers’ insecurity with caregiving and dependence of the injured.

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Progressive post-traumatic syringomyelia: a clinical case

Russian journal of neurosurgery ◽

10.17650/1683-3295-2019-21-4-81-88 ◽

2019 ◽

Vol 21 (4) ◽

pp. 81-88

Author(s):

F. A. Bushkov ◽

M. A. Bzhylyanskiy ◽

A. Yu. Kordonskiy

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Informed Consent ◽

Conflict Of Interest ◽

Clinical Case ◽

Spinal Injury ◽

Spinal Column ◽

Cord Injury ◽

Post Traumatic ◽

The Right

The objective of the present article is to describe a rare clinical case of progressive post-traumatic cervical syringomyelia after spinal cord injury with fracture of proximal metaepiphysis of the right humerus. The patient had a progressive neurological loss after spinal cord injury.Materials and methods. The patient underwent surgical treatment: decompression and stabilization of spinal column, surgical technique of spinal cord detethering, cyst shunting.Results. In the postoperative period the patient had increased spasticity in the lower extremities, increased weakness in the muscles of the upper extremities, aggravation of orthostatic hypotension, and inability to flex the first and the fifth fingers of the right hand. Magnetic resonance imaging of the cervical spine revealed progression of syringomyelia.Conclusion. This case demonstrates differentiation between cervical myelopathy and plexus paresis in a patient with combination spinal injury and reveals the mechanisms underlying late progression of neurological deficit.Conflict of interest. The authors declare no conflict of interest.Informed consent. The patient gave written informed consent to the publication of his data.

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Pediatric spinal injury: the very young

Journal of Neurosurgery ◽

10.3171/jns.1988.68.1.0025 ◽

1988 ◽

Vol 68 (1) ◽

pp. 25-30 ◽

Cited By ~ 196

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.

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Long-term outcome of paediatric spinal cord injury

Trauma ◽

10.1177/1460408617706387 ◽

2017 ◽

Vol 19 (1_suppl) ◽

pp. 75-82 ◽

Cited By ~ 1

Author(s):

Richa Kulshrestha ◽

Naveen Kumar ◽

J Roy Chowdhury ◽

Aheed Osman ◽

W El Masri

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Spinal Cord Injuries ◽

Spinal Injury ◽

Social Outcomes ◽

Long Term Outcomes ◽

Cord Injury ◽

Post Traumatic ◽

Clinical Records

Background Spinal cord injuries are relatively uncommon in children and evidence about long-term outcomes is limited. This study was performed to determine the frequency of common long-term complications in patients sustaining spinal injury in childhood (0–18 years) and who were followed up at a single dedicated spinal injuries centre in the UK. Method A retrospective review of clinical records of all patients injured at or less than 18 years of age between 1971 and 1999. Complications studied were renal, bowel, musculoskeletal, pressure ulcers and post-traumatic syringomyelia. Long-term social outcomes of independence, employment and driving were also assessed. Results Of 69 individuals (47 males, 22 females) the median age at injury was 17 years (range 0–18 y); 68% were older than 13 years at injury and 74% had traumatic injuries. Patients had an average duration of 27 years (12–43 years) of spinal injury – half had a neurological level of T6 and above, 80% had paraplegia and 20% had quadriplegia. Discussion Patients with both complete and incomplete spinal cord injury have minimal neurological recovery. Managing medical complications is vital as only 11.5% had normal voiding and 10.6% had normal bowel function. The incidence of skin ulcers increases with duration of spinal cord injury and scoliosis is higher in the non-traumatic injury group. Spasticity is observed in 66.6% and post-traumatic syringomyelia in 11.7%. Long-term social outcomes are good with 75% patients able to do independent care, 46% could drive and 39% managed employment or higher education. Conclusions This study documents the long-term outcomes and complications of spinal cord injuries sustained in childhood. With initial active physiological conservative management of the majority of patients, patient education and ongoing support the majority of patients achieved long-term survival and led independent and productive lives.

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Traumatic Spinal Cord Injury: Long-Term Motor, Sensory, and Urinary Outcomes

Asian Spine Journal ◽

10.4184/asj.2017.11.3.412 ◽

2017 ◽

Vol 11 (3) ◽

pp. 412-418 ◽

Cited By ~ 7

Author(s):

Rouzbeh Motiei-Langroudi ◽

Homa Sadeghian

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Spinal Injury ◽

Treatment Protocol ◽

Spinal Column ◽

Surgical Approaches ◽

Trauma Mechanism ◽

Cord Injury

<sec><title>Study Design</title>Retrospective study.</sec><sec><title>Purpose</title>To evaluate how motor, sensory, and urinary outcomes of spinal cord injury (SCI) patients were influenced in the long term.</sec><sec><title>Overview of Literature</title>SCI is a potentially disabling and devastating neurological outcome that can occur because of spinal column fractures. Most studies have not evaluated or have failed to show the influence of different surgical approaches and other parameters on neurological recovery.</sec><sec><title>Methods</title>A thorough history regarding sensory, motor, and urinary complaints was taken from 103 patients with SCI due to vertebral fracture; patients were followed by a thorough neurological examination. Subsequently, all medical records of patients, including neurological state after trauma, trauma mechanism, treatment protocol, surgical protocol, and imaging findings, were evaluated.</sec><sec><title>Results</title>Of the 103 patients, 73.8% were survivors of a major earthquake and 26.2% were victims of vehicle accidents; 92.2% patients were surgically treated, while 7.8% underwent conservative management. The mean follow-up duration was 10.3 years. In follow-up visits, 67.0%, 12.6%, 13.6%, and 6.8% patients showed no, partial, substantial, and complete motor improvement, respectively; 68.0%, 26.2%, and 5.8% showed no, mild, and substantial sensory improvement, respectively; and 73.8%, 17.5%, and 8.7% showed no, substantial, and complete urinary improvement, respectively. Logistic regression analysis showed that sex, age at injury time, follow-up duration, trauma mechanism, and stem cell therapy had no effect on motor, sensory, and urinary improvement. Higher initial scores on the American Spinal Injury Association (ASIA) classification, lumbar fracture level, and performance of laminectomy improved motor outcome; higher initial ASIA scores improved urinary and sensory outcomes.</sec><sec><title>Conclusions</title>The initial ASIA score is the most important factor for prognosticating motor, sensory, and urinary improvement in SCI patients. Lumbar (L3–L5) and thoracic (T1–T10) fractures have the best and worst prognosis, respectively, in terms of motor recovery. Laminectomy during surgery improves motor function.</sec>

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International Standards for Neurological Classification of Spinal Cord Injuries (ASIA/ISNCSCI scale, revised 2015) 67

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors4267-72 ◽

2016 ◽

Vol 4 (2) ◽

pp. 67-72 ◽

Cited By ~ 1

Author(s):

Sergei V Vissarionov ◽

Alexei G Baindurashvili ◽

Irina A Kryukova

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Spinal Cord Injuries ◽

Spinal Injury ◽

Neurological Status ◽

International Standards ◽

American Spinal Injury Association ◽

Cord Injury ◽

Important Challenge

Standardization of neurological examination and diagnosis in the case of spinal injury is currently an important challenge in neurotraumatology. At present, most organizations, worldwide, that are involved with spinal injuries, apply the International Standards for Neurological Classifications of Spinal Cord Injury (ISNCSCI), drafted by American Spinal Injury Association (ASIA) and approved in 1992. The ASIA/ISNCSCI scale is a quantitative system for estimation of the neurological status of spinal cord injury patients. The ASIA/ISNCSCI scale has been repeatedly updated and revised since 1992. The 2015 version of the ISNCSCI on the American Spinal Injury Association website is demonstrated in this study, and the form and testing instruction are translated into Russian.

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Classifications Used in Spinal Cord Injuries

Sinir Sistemi Cerrahisi Dergisi ◽

10.5222/sscd.2021.84856 ◽

2021 ◽

Author(s):

Erek Öztürk ◽

Yener Akyuva ◽

Erdinç Çivelek

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Spinal Cord Injuries ◽

Spinal Injury ◽

Functional Independence ◽

International Standards ◽

Data Set ◽

Multidimensional Pain Inventory ◽

Cord Injury

Creating a common language allows information to be shared well/wholesome/healthily. Classifications have a important role in the formation of this language, which provides many benefits such as follow-up of the clinical course. Classifications in spinal cord injuries are based on examination, so the results of different treatments can be revealed more clearly with a standardized examination and registration. The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) which is the most sensitive and common classification was developed by the American Spinal Injury Association (ASIA) and the International Spinal Cord Society (ISCoS), although its foundations were laid in 1969 by Frankel. Apart from neurological evaluation, there are scales such as Functional Independence Scale, Modified Barthel Index, Spinal Cord Independence Scale, Quadriplegia Functional Index, Walking Index for Spinal Cord Injury, Spinal Cord Injury Functional Ambulation Inventory to determine the functional status in spinal cord injuries. Additionally scales such as Assessment of Spinal Cord Injury Basic Pain Data Set, Multidimensional Pain Inventory, DN4 (DouleurNeuropathique DN4) can be used for pain assessment in a patient with spinal cord injury.

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Active physiological conservative management in traumatic spinal cord injuries – an evidence-based approach

Trauma ◽

10.1177/1460408617698508 ◽

2017 ◽

Vol 19 (1_suppl) ◽

pp. 10-22 ◽

Cited By ~ 2

Author(s):

W El Masri ◽

Naveen Kumar

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Conservative Management ◽

Spinal Cord Injuries ◽

Spinal Injury ◽

Surgical Decompression ◽

The Body ◽

Prognostic Indicators ◽

Number Of Patients ◽

Cord Injury

The management of the traumatic spinal cord injury remains controversial. Guttmann demonstrated that with simultaneous attention to all medical and non-medical effects of the spinal cord injury, a significant number of patients recovered motor and sensory functions to ambulate and the majority were pain-free following conservative management. Active physiological conservative management of the spinal injury requires simultaneous scrupulous care of the injured spine together with; the multisystem neurogenic effects of the spinal cord injury on the respiratory, cardiovascular, urinary, gastrointestinal, dermatological, sexual and reproductive functions; the management of the associated psychological effects of paralysis from the early hours or days of injury as well as; the physical rehabilitation and modification of the environment. To date, there is no evidence to suggest that the surgical decompression and/or stabilisation of the neurologically impaired spinal cord injury patient is advantageous. This article considers the debates and evidence of surgical management including the effects of timing of the surgical decompression. Also addressed are the factors influencing decisions on management, prognostic indicators of recovery and natural history of complete and incomplete cord injuries. Traumatic biomechanical instability of the spine, physiological instability of the spinal cord, traumatic spinal canal encroachment and traumatic cord compression are also discussed. Early mobilisation, indications for surgery at the RJAH and economic considerations of spinal cord injuries are presented. The ultimate goals of the active physiological conservative management are to ensure maximum neurological recovery and independence, a pain-free and flexible spine, safe and convenient functioning of the various systems of the body with minimal inconvenience to patients and the prevention of complications.

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A Model for the Future Care of Acute Spinal Cord Injuries

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100020497 ◽

1975 ◽

Vol 2 (4) ◽

pp. 361-380 ◽

Cited By ~ 29

Author(s):

E.H. Botterell ◽

A.T. Jousse ◽

A.S. Kraus ◽

M.G. Thompson ◽

M. Wynne-Jones ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Spinal Cord Injuries ◽

Sports Injuries ◽

Spinal Column ◽

Injured Patient ◽

Rehabilitation Program ◽

Time Of Day ◽

Water Age ◽

Cord Injury

SUMMARY:This is a review of the total care of those acute spinal cord injury patients in Ontario during the years 1969 and 1970, from extrication and transportation following the accident to death, or the completion of primary definitive rehabilitation.Information was extracted from the available ambulance records, the patients and many of the responsible physicians were interviewed personally. The study was detailed and intensive and included a review of each patient's hospital records in each hospital up to discharge from the rehabilitation programme into the community, or to a chronic care unit. The data was compiled in accordance with a detailed and lengthy questionnaire developed for this study.The incidence of acute cord injuries in Ontario in 1969 and 1970 amounted to 244; in 1969, 15.9 per million population and in 1970, 13.6 per million. As in other studies road accidents took first place, followed by falls from a height; sports injuries ranked third and 65.7% of these were caused by diving into shallow water. Age incidence, and incidence by month, day of week and time of day were identified. Fridays and Saturday afternoons in July and August are particularly hazardous.The study continued to the end of 1974 by which time 34 deaths had been recorded. Peak incidence of death occurred within fourteen days of injury. The most common cause of death was respiratory in origin.Geographical distribution was identified and the type of hospital treating the acutely injured patient.Fourteen percent of persons with spinal column injury suffered progressive or sequential spinal cord damage both prior to and following medical contact. The incidence of pressure sores and genitourinary sepsis and calculosis was high in all types of hospitals. The effect of operative treatment was noted in the cases of complete quadriplegia and paraplegia.Of the 133 survivors who undertook a rehabilitation program, 84% returned to their homes and 59% achieved gainful employment or ongoing education.The cost was determined of general hospital services and rehabilitation programmes.A new model for the care of the spinal cord injury patients in Ontario was proposed.

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