Management strategies for acute spinal cord injury

Stahel, Philip F.; VanderHeiden, Todd F.; Finn, Michael A.

doi:10.1097/mcc.0b013e32835a0e54

Cited by 66 publications

(49 citation statements)

References 100 publications

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“…Use of corticosteroids remains controversial, with most current guidelines recommending against administration. 29,30 This study has several limitations resulting chiefly from its retrospective nature and the lack of availability of neuroimaging for independent review. Classification of injuries was based on radiologic reports and spine surgeon consultation notes.…”

Section: Discussionmentioning

confidence: 99%

Cervical Spine Injury Patterns in Children

Leonard¹,

et al. 2014

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BACKGROUND AND OBJECTIVE: Pediatric cervical spine injuries (CSIs) are rare and differ from adult CSIs. Our objective was to describe CSIs in a large, representative cohort of children. METHODS: We conducted a 5-year retrospective review of children <16 years old with CSIs at 17 Pediatric Emergency Care Applied Research Network hospitals. Investigators reviewed imaging reports and consultations to assign CSI type. We described cohort characteristics using means and frequencies and used Fisher’s exact test to compare differences between 3 age groups: <2 years, 2 to 7 years, and 8 to 15 years. We used logistic regression to explore the relationship between injury level and age and mechanism of injury and between neurologic outcome and cord involvement, injury level, age, and comorbid injuries. RESULTS: A total of 540 children with CSIs were included in the study. CSI level was associated with both age and mechanism of injury. For children <2 and 2 to 7 years old, motor vehicle crash (MVC) was the most common injury mechanism (56%, 37%). Children in these age groups more commonly injured the axial (occiput–C2) region (74%, 78%). In children 8 to 15 years old, sports accounted for as many injuries as MVCs (23%, 23%), and 53% of injuries were subaxial (C3–7). CSIs often necessitated surgical intervention (axial, 39%; subaxial, 30%) and often resulted in neurologic deficits (21%) and death (7%). Neurologic outcome was associated with cord involvement, injury level, age, and comorbid injuries. CONCLUSIONS: We demonstrated a high degree of variability of CSI patterns, treatments and outcomes in children. The rarity, variation, and morbidity of pediatric CSIs make prompt recognition and treatment critical.

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Section: Discussionmentioning

confidence: 99%

Cervical Spine Injury Patterns in Children

Leonard¹,

et al. 2014

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“…1,2 Hence, the importance of identifying novel pathomechanisms, possibly extramedullary events like spinal subarachnoid bleeding (SSB), that could become targets for new therapeutic strategies. SSB occurs after clinical 3 and experimental 4,5 traumatic SCI.…”

Section: Introductionmentioning

confidence: 99%

Characterization of spinal subarachnoid bleeding associated to graded traumatic spinal cord injury in the rat

et al. 2014

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Study design: Observational study in rats subjected to traumatic spinal cord injury (SCI). Objectives: To describe the features of spinal subarachnoid bleeding (SSB) occurring after graded SCI. SSB after SCI has been reported previously, but has not been studied systematically despite the fact that cerebral subarachnoid bleeding often produces severe neurological damage. Setting: Mexico. Methods: Anesthetized rats were subjected to mild or severe spinal cord contusion at T9. Occurrence, size, progression and location of SSB were characterized morphologically and scored from T7-T12 at 1 h and 1, 3 and 7 days post injury. Besides, contusions were videotaped to visualize bleeding at the moment of impact. Results: SSB started immediately after contusion (severe or mild) and decreased gradually over time. For all vertebral segments, at all time points examined by histology, 48% of areas scored after severe contusion showed bleeding: 25% minor, 17% moderate and 6% major. After mild contusion, only 15% showed bleeding: 13 minor and 2% moderate. Maximum bleeding occurred early after injury in dorsal area of the epicenter in 100% of severe contusions (6% minor, 38 moderate and 56% major), and in 69% of mild contusions (63 minor and 6% moderate). Conclusion: Here, we detail SSB patterns occurring after graded SCI. Further studies are warranted to elucidate the possible role extramedullary events, such as SSB, in the pathophysiology of SCI that might encourage the development of new strategies for its management.

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“…The main points of pre-hospital care in SCI are protection of airway patency, restoring respiration, initiation of fluid therapy and spinal immobilization (Stahel et al, 2012). Primarily, hypoxia and hypercapnia should be prevented in order to minimize the damage and protect neural tissue; and volume replacement is required to prevent tissue hypoxia.…”

Section: Emergency Approach In Spinal Cord Injuries Pre-hospital Periodmentioning

confidence: 99%

“…Primarily, hypoxia and hypercapnia should be prevented in order to minimize the damage and protect neural tissue; and volume replacement is required to prevent tissue hypoxia. Until proven otherwise, patients with neck and back pain or tenderness should be considered as if there is spinal and/or spinal cord injury (Baron et al 2011;Stahel et al, 2012). Cervical spine should be stabilized with a rigid cervical collar and supported by tape or sandbags.…”

Section: Emergency Approach In Spinal Cord Injuries Pre-hospital Periodmentioning

confidence: 99%

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Management of spinal trauma in emergency department

Akdemir¹,

Katı²,

Duran³

et al. 2014

jecm

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Spinal cord injuries are traumatic incidents which lead to serious clinical consequences and affect the lives of individuals and their families. Despite all medical and surgical advances, optimal treatment still remains a serious clinical problem. It is mostly not possible to prevent the primary injury arising from trauma exposure in spite of all measures taken. However, some biochemical events developing in spinal cord following the primary injury cause more damage to the cord. This process also defined as the secondary injury increases the importance of emergency department approach to patients with acute spinal trauma. Emergency department practices in spinal cord injuries are extremely important in terms of both primary care and prevention of complications.

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Management strategies for acute spinal cord injury

Cited by 66 publications

References 100 publications

Cervical Spine Injury Patterns in Children

Cervical Spine Injury Patterns in Children

Characterization of spinal subarachnoid bleeding associated to graded traumatic spinal cord injury in the rat

Management of spinal trauma in emergency department

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