Introductory Chapter: Spinal Cord Injury (original) (raw)

Pathophysiology, presentation and management of spinal cord injury

Surgery (Oxford), 2015

Spinal cord impairment (SCI) may arise from traumatic and non-traumatic causes. Traumatic causes include blunt trauma and penetrating injury. Examples of non-traumatic causes include cord compression from disc prolapse or bone metastasis from a primary cancer. SCI leads to complete loss or altered motor function and sensation, and disruption of autonomic function. SCI can be described by level of vertebral column injury and by level and severity of neurological deficit using the International Standards for Neurological Classification of Spinal Cord Injury developed by the American Spinal Injury Association as a universal classification tool for SCI. This classification tool involves sensory and motor examination to determine neurological level of injury and whether the injury is complete or incomplete. Acute SCI patients have a complex and evolving pathophysiology and it is important to appreciate the altered physiology particularly in the acute stages of management. Intensive care monitoring and surgical intervention are likely to be required to manage the altered physiology and vertebral column injuries respectively. A multidisciplinary approach with specialist SCI centre input ensures optimal management from time of diagnosis and has been shown to have a significant effect on long-term functional outcome for patients. Since August 2013 a national pathway has been in place to facilitate rapid referral from a major trauma centre to an SCI Centre. The pathway sets out key goals and objectives to be achieved within defined time frames as the patient moves from the acute phase of injury into the rehabilitation and reintegration phase.

Rehabilitation of spinal cord injuries

World Journal of Orthopedics, 2015

Spinal cord injury (SCI) is the injury of the spinal cord from the foramen magnum to the cauda equina which occurs as a result of compulsion, incision or contusion. The most common causes of SCI in the world are traffic accidents, gunshot injuries, knife injuries, falls and sports injuries. There is a strong relationship between functional status and whether the injury is complete or not complete, as well as the level of the injury. The results of SCI bring not only damage to independence and physical function, but also include many complications from the injury. Neurogenic bladder and bowel, urinary tract infections, pressure ulcers, orthostatic hypotension, fractures, deep vein thrombosis, spasticity, autonomic dysreflexia, pulmonary and cardiovascular problems, and depressive disorders are frequent complications after SCI. SCI leads to serious disability in the patient resulting in the loss of work, which brings psychosocial and economic problems. The treatment and rehabilitation period is long, expensive and exhausting in SCI. Whether complete or incomplete, SCI rehabilitation is a long process that requires patience and motivation of the patient and relatives. Early rehabilitation is important to prevent joint contractures and the loss of muscle strength, conservation of bone density, and to ensure normal functioning of the respiratory and digestive system. An interdisciplinary approach is essential in rehabilitation in SCI, as in the other types of rehabilitation. The team is led by a physiatrist and consists of the patients' family, physiotherapist, occupational therapist, dietician, psychologist, speech therapist, social worker and other consultant specialists as necessary.

A multicentre follow-up of clinical aspects of traumatic spinal cord injury

Spinal Cord, 2006

Study design: Prospective, multicentred follow-up (FU) observational study. Objectives: Prospectively evaluate survival, complications, re-admissions and maintenance of clinical outcome in people experiencing traumatic spinal cord injury (SCI). Setting: Seven spinal units and 17 rehabilitation centres participating in the previous GISEM (ie Italian Group for the Epidemiological Study of Spinal Cord Injuries) study. Method: A total of 511 persons with SCI, discharged between 1997 and 1999 after their first hospitalisation, were enrolled. A standardised questionnaire was administered via telephone. Results: Of the 608 persons originally enrolled, 36 died between discharge and follow-up (mean 3.870.64 years). Of the remainder, 403 completed telephone interviews, 72 refused to participate and 97 could not be contacted. More than half of the patients interviewed (53.6%) experienced at least one SCI-related clinical problem in the 6 months preceding interview; the most frequent being urological complications (53.7%). At least one re-admission was recorded in 56.8% of patients between discharge and FU interview. Of the patients interviewed, 70.5% reported bowel autonomy and 86% bladder management autonomy. On multivariate analysis, lack of bowel/bladder autonomy was the most common variable with a strong predicting value for mortality, occurrence of complications and re-admissions. Conclusion: Re-admission and major complications seem common after SCI and should be considered when planning facilities. Failure to obtain bowel/bladder autonomy upon discharge from rehabilitation proved to be the most common predictive factor of poor outcome during the period between discharge and FU interview.

A brief history of therapy for traumatic spinal cord injury

Neurosurgical Focus, 2004

There are few more devastating injuries that afflict man than those associated with spinal cord injury (SCI). The economic, psychological, and social impact are encompassing and enormous to the individual and society. During the last several years, there has been a renewed interest in the study of SCI, with the hope of finding a cure. It is appropriate, then, to examine the efforts accomplished throughout medical history. With this retrospective view, potential avenues for future treatment become more apparent and clear. As in the past, the integration of basic science and clinical innovation will create the path toward progress for treatment of this disease.

Effect of Various Treatment Modalities After Spinal Cord Injury

Acta Scientific Orthopaedics

Spinal cord injury (SCI) is a devasting neurological condition producing physical dependency, morbidity, psychological stress and financial burden, Spinal cord injury is characterized by the degradation of motor, sensory and autonomic functions either because of wholly or partially damage in the spinal cord because of trauma. Its a debilitating neurological condition with socio economic impact on affected individuals and the health care system, It completely changed subjects life because it's a life long treatment and loss of income and patient completely depend on others. According to Ara Z., et al. 2022 SCI is a life threatning process and it greatly effects subjects' quality of life and families, In 1700 BC in an Egyptian surgical papyrus, they describe the frustration of health care professionals in treating a severe spinal cord injury, the Papyrus reported spinal fractures as a ''disease that should not be treated''. Most of these studies approach a patient with acute spinal cord injury (ASCI) in one of four manners: corrective surgery or a physical, biological or pharmacological treatment method. clinically, we only provide supportive care for patients with spinal cord injuries. By combining these treatments, researchers attempt to enhance the functional recovery of patients with spinal cord injuries. Advances in the last decade have allowed us to encourage the development of experimental studies in the field of spinal cord regeneration.

Traumatic Spinal Cord Injury Research Project

Traumatic Spinal Cord Injury is a neurological condition that has an impact on one's ability to be fully independent, financially sound, and physically active as before injury and is a lifetime condition. (Falvo, 108). Various catalysts result in Traumatic Spinal Cord Injuries that can cause a person to lose the ability to walk or use their arms and hands if extensive damage is done without immediate medical attention. Statistics from the National Spinal Cord Injury Center indicate that there are 12,500 new cases annually and that they are caused by incidents of blunt force trauma such as traffic accidents, acts of violence, sports injuries, or falls, and occur more often in adults and younger women than children. (Alizedah, 2019). "The degree of functional loss depends on the degree to which the spinal cord is injured and the location of injury." (Falvo, 95). Patients with Traumatic Spinal Cord Injuries are left with varying levels of spinal cord injuries such as "paraplegia or tetraplegia" (Alizadeh, 2019). At times, paraplegia, defined as paralysis of the legs and lower body, may be incomplete, and could potentially result in the possibility of regaining mobility with prompt medical attention. Another form of Traumatic Spinal Cord Injury is tetraplegia, also referred to as quadriplegia, which results in complete loss of movement in the upper and lower body, or from the neck down, extended to the trunk, legs, and arms. The damage from a spinal cord injury is not only debilitating but with a general prognosis, is irreversible. STEM cell regeneration treatment is one of the most promising experimental models to support spinal cord repair, however, "Rehabilitation, currently the only available treatment does not restore damaged tissues; therefore, the functional recovery of

Spinal Cord Injury: Modern Clinical Management and Its Correlation to Advances in Basic Science

Animal Models of Spinal Cord Repair, 2012

This chapter re fl ects the yearning for discoveries within the fi eld of spinal cord injury (SCI) and points out the dif fi culties, opportunities, as well as possibilities to relate and translate the results from basic science to clinical management. After a brief presentation of "spinal cord history," we provide a short overview of the cornerstones of modern management of patients with SCI. This overview will, besides introducing basic scientists in the fi eld of clinical practice, also expose the inherent imprecision of everyday clinical care compared to the high methodological requirements of experimental SCI research. We will focus our presentation on medical management aimed at preventing the consequences of secondary injury in the acute period, i.e., neuroprotection. A brief overview of various techniques of neural regeneration in the subacute (late) and chronic phase will follow this. Finally, based on the progress in basic science within the fi elds of neuroprotection and regeneration, some thoughts about future clinical therapeutic avenues will be discussed.

Spinal cord injury – there is not just one way of treating it

F1000Prime Reports, 2014

In the last century, research in the field of spinal cord trauma has brought insightful knowledge which has led to a detailed understanding of mechanisms that are involved in injury-and recovery-related processes. The quest for a cure for the yet generally incurable condition as well as the exponential rise in gained information has brought about the development of numerous treatment approaches while at the same time the abundance of data has become quite unmanageable. Owing to an enormous amount of preclinical therapeutic approaches, this report highlights important trends rather than specific treatment strategies. We focus on current advances in the treatment of spinal cord injury and want to further draw attention to arising problems in spinal cord injury (SCI) research and discuss possible solutions.