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.

Complications associated with the prophylactic use of methylprednisolone during surgical stabilization after spinal cord injury

2002 ◽  
Vol 96 (3) ◽  
pp. 267-272 ◽  
Author(s):  
Maria Del Rosario Molano ◽  
James G. Broton ◽  
Judy A. Bean ◽  
Blair Calancie
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spine Surgery ◽  
Spinal Injury ◽  
Content Type ◽  
Cord Injury ◽  
Prophylactic Use ◽  
Initial Hospitalization ◽  
Fine Print

Object. The authors attempted to determine if there is a significant relationship between the incidence of medical complications and the prophylactic use of methylprednisolone (MP) during spine surgery in patients with acute spinal cord injury (SCI) who had already received MP on hospital admission (typically in the setting of an Emergency Room/Trauma Center). Methods. The authors studied 73 patients with acute SCI who were admitted to the hospital for at least 7 days postinjury. All patients 1) received a 24-hour regimen of MP in the acute period of hospitalization; and 2) underwent surgery to stabilize the spine and/or decompress the spinal cord. Patients were separated into two groups on the basis of whether they received additional MP therapy during spine surgery. A chart review was conducted retrospectively to determine the incidence of complications up to 6 weeks postinjury. Muscle strength and American Spinal Injury Association grades were determined prospectively throughout the follow-up period. In patients who received two courses of MP following acute SCI (one at initial hospitalization and one during surgery), a significantly increased probability of complications was demonstrated compared with those who received no MP therapy during surgery. This was particularly evident when the incidences of serious complications were compared. Conclusions. Prophylactic use of MP as a neuroprotective agent during spine surgery in patients with acute SCI should be avoided in those in whom MP was administered on admission to the hospital.

scholarly journals Olfactory ensheathing cell transplantation for chronic spinal cord injury: A long-term follow-up study

2021 ◽  
Vol 9 (2) ◽  
pp. 94-105
Author(s):  
Naifeng Kuang ◽  
Xiaoyu Wang ◽  
Yuexia Chen ◽  
Guifeng Liu ◽  
Fan’e Kong ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Autonomic Function ◽  
Spinal Injury ◽  
International Standards ◽  
Olfactory Ensheathing Cell ◽  
Cord Injury ◽  
Long Term Follow Up

Spinal cord injury is a serious disabling condition. Transplantation of olfactory ensheathing cells (OECs) is one of the most promising treatments for spinal cord injury (SCI). Thirty-nine patients with chronic SCI received OEC transplantation and completed long-term follow-up, with a minimum follow-up of 7 years. We assessed sensorimotor function with the American Spinal Injury Association (ASIA) Impairment Scale (AIS) and autonomic nervous function by the International Standards to document remaining Autonomic Function after Spinal Cord Injury (ISAFSCI), and sympathetic skin responses (SSR). The scores of each group were significantly higher after OECs transplantation than before treatment. SSR latencies were shorter and response amplitudes increased after treatment. Long-term follow-up showed further improvement only in motor function and autonomic function compared with 3 months postoperatively. No complications occurred in any patient during long-term follow-up. The results indicate that the transplantation of OECs in spinal cord restored function without serious side effects.

Thienylphencyclidine protection for the spinal cord of adult rats against extension of lesions secondary to a photochemical injury

1993 ◽  
Vol 78 (4) ◽  
pp. 603-609 ◽  
Author(s):  
Philippe Pencalet ◽  
Freddy Ohanna ◽  
Philippe Poulat ◽  
Jean-Marc Kamenka ◽  
Alain Privat
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Neurological Impairment ◽  
Treated Group ◽  
Untreated Group ◽  
Spinal Cord Infarction ◽  
Adult Rats ◽  
Content Type ◽  
Arterial Blood ◽  
Cord Injury

✓ The purpose of this study was to evaluate treatment with the N-methyl-D-aspartate antagonist thienylphencyclidine (TCP) after spinal cord injury for its behavioral, electrophysiological, morphological, and immunohistochemical effects. Five minutes after a photochemical lesion was produced in rats at the T-8 level, the animals received TCP (1 mg/kg, intravenously) or TCP vehicle (saline). The animals were evaluated on Day 18 for neurological recovery by testing motor and sensory functions. The TCP-treated group showed less neurological impairment than the untreated group (p < 0.05 for inclined-plane stability and withdrawal reflex to extension). Somatosensory evoked potential testing was performed on Days 21 to 23 and the wave amplitude between the onset and P1 in the TCP-treated group was higher than in the untreated group (p < 0.05). Mean arterial blood pressure was not significantly modified after TCP injection. Morphometric studies of the lesion area in cross section revealed a significantly reduced spinal cord infarction in the TCP-treated group (p < 0.05). Immunohistochemical evaluation of the spinal cord in lumbar area showed an increased level of serotonin immunoreactivity in the dorsal horn of animals treated by TCP. These results demonstrate the efficacy of TCP in reducing secondary lesions after spinal cord injury in rats.

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.

Long-Term Follow-up of Patients with Spinal Cord Injury

2005 ◽  
Vol 19 (4) ◽  
pp. 332-337 ◽  
Author(s):  
Figen Yilmaz ◽  
Fusun Sahin ◽  
Semra Aktug ◽  
Banu Kuran ◽  
Adem Yilmaz
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Injury ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
American Spinal Injury Association ◽  
Cord Injury ◽  
Long Term Follow Up

Objective. The aim of this study was to evaluate the motor, sensory, and functional recovery in patients with spinal cord injury (SCI). Methods. Forty-one patients with SCI participated in this study. Twenty patients were evaluated after discharge. Each patient was evaluated by the American Spinal Injury Association (ASIA) impairment scale and the Functional Independence Measure (FIM) at admission, before discharge, and at least at 6 months after discharge. Friedman, Dunn, and Mann-Whitney U tests were used for statistical analysis. Results. There were 17 male and 3 female patients. Seven patients had complete SCI, and 13 patients had incomplete SCI. The evaluation of motor, sensory, and FIM scores at admission showed significant improvement in all of the patients during the follow-up period (P < 0.0001). Five incompletely injured cases improved with regard to ASIA staging. Motor and FIM scores significantly increased at follow-up for converted and unconverted patients. All parameters increased at follow-up in patients who were complete and incomplete. Motor scores significantly increased at discharge and at follow-up. FIM scores also increased significantly at follow-up in incomplete patients. Conclusion. Motor, sensory, and FIM scores increased in patients with SCI after a follow-up period of 18 months. Improvement to a higher ASIA stage could be accomplished by 25% of the patients. Although both complete and incomplete patients recovered significantly at the follow-up period, only incompletely injured cases could convert to a higher ASIA stage.

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.

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.

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.

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

2017 ◽  
Vol 11 (3) ◽  
pp. 412-418 ◽  
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><p>Retrospective study.</p></sec><sec><title>Purpose</title><p>To evaluate how motor, sensory, and urinary outcomes of spinal cord injury (SCI) patients were influenced in the long term.</p></sec><sec><title>Overview of Literature</title><p>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.</p></sec><sec><title>Methods</title><p>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.</p></sec><sec><title>Results</title><p>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.</p></sec><sec><title>Conclusions</title><p>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.</p></sec>

scholarly journals Outcome in patients undergoing surgery for spinal injury in an Ethiopian hospital

2015 ◽  
Vol 23 (6) ◽  
pp. 772-779 ◽  
Author(s):  
Martin Andreas Lehre ◽  
Lars Magnus Eriksen ◽  
Abenezer Tirsit ◽  
Segni Bekele ◽  
Saba Petros ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Surgical Treatment ◽  
Motor Vehicle ◽  
Spinal Injury ◽  
Addis Ababa ◽  
Cord Injury ◽  
Spine Injuries ◽  
Tract Infections

OBJECT The objective of this study was to investigate epidemiology and outcome after surgical treatment for spinal injuries in Ethiopia. METHODS Medical records of patients who underwent surgery for spine injuries at Myungsung Christian Medical Center in Addis Ababa, Ethiopia, between January 2008 and September 2012 were reviewed retrospectively. Assessment of outcome and complications was determined from patient consultations and phone interviews. RESULTS A total of 146 patients were included (129 males, 17 females). Their mean age was 31.7 years (range 15–81 years). The leading cause of injury was motor vehicle accidents (54.1%), and this was followed by falls (26.7%). The most common injury sites were lumbar (41.1%) and cervical (34.2%) regions of the spine. In 21.2% of patients, no neurological deficit was present before surgery, 46.6% had incomplete spinal cord injury (American Spinal Injury Association [ASIA] Impairment Scale [AIS] Grade B-D), and 32.2% had complete spinal cord injury (AIS Grade A). Follow-up was hampered by suboptimal infrastructure, but information regarding outcome was successfully obtained for 110 patients (75.3%). At follow-up (mean 22.9 months; range 2–57 months), 25 patients (17.1%) were confirmed dead and 85 patients (58.2%) were alive; 49 patients (33.6%) underwent physical examination. At least 8 of the 47 patients (17.0%) with a complete injury and 29 of the 68 patients (42.6%) with an incomplete injury showed neurological improvement. The reported incidences of pressure wounds, recurrent urinary tract infections, pneumonia, and thromboembolic events were 22.5%, 13.5%, 5.6%, and 1.1%, respectively. CONCLUSIONS Patients showed surprisingly good recovery considering the limited resources. Surgical treatment for spine injuries in Ethiopia is considered beneficial.

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