Compound Injuries of the Spinal Cord

Tinsley, M

doi:10.3171/jns.1946.3.4.0306

Cited by 21 publications

(5 citation statements)

References 1 publication

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“…15,28,29,37,42 Previously unheard of results were being reported. In Pool's series 32 of 57 patients treated during the years 1943-1944, 35 underwent a laminectomy and 57% showed a marked neurological improvement, compared with 4.5% spontaneous improve- Fig.…”

Section: Historymentioning

confidence: 99%

“…42 At the onset of World War II (1939)(1940)(1941)(1942)(1943)(1944)(1945), surgeons were faced with another onslaught of PSIs with little treatment to offer as a result of the continuation of the fatalistic attitude born through the previous conflicts. As stated by Dr. Milton Tinsley, "This was the confusion existing when we began to care for compound spinal injuries in World War II."…”

Section: Historymentioning

confidence: 99%

“…As stated by Dr. Milton Tinsley, "This was the confusion existing when we began to care for compound spinal injuries in World War II." 42 Before becoming one of the founding fathers of pediatric neurosurgery, then Major Donald Matson 28 summarized the feelings of many surgeons: "This has always been a difficult and discouraging group of cases to treat and perhaps for this reason they have been neglected. "…”

Section: Historymentioning

confidence: 99%

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Can surgery improve neurological function in penetrating spinal injury? A review of the military and civilian literature and treatment recommendations for military neurosurgeons

Klimo

Ragel

Rosner

et al. 2010

FOC

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Neurosurg Focus 28 (5):E4, 20101 P atients with PSIs present very complex, multidisciplinary management challenges for military surgeons. Not only can the patient have immediate and delayed life-threatening damage to organs along the path of the projectile, the spinal column and possibly the neurological structures contained within can also, by definition, suffer injury, the severity of which depends on multiple factors. Spinal cord injury from spinal GSWs is more often a complete lesion with a decreased potential for neurological recovery than with closed trauma. 43There are a number of potential surgical indications, the most controversial of which is whether decompressive laminectomy has any effect on neurological recovery. Medical civilian and military literature is replete with opinions for and against the use of surgery.Although missile characteristics such as size, composition and design are important, the major determinant of the destructive ability of a projectile is velocity at impact and thus the kinetic energy imparted to the surrounding tissue.10 Energy is calculated based on mass and velocity as follows: energy = 1/2mv 2 . Therefore, velocity has a significantly greater effect on energy than projectile mass. Object. Penetrating spinal injury (PSI), although an infrequent injury in the civilian population, is not an infrequent injury in military conflicts. Throughout military history, the role of surgery in the treatment of PSI has been controversial. The US is currently involved in 2 military campaigns, the hallmark of both being the widespread use of various explosive devices. The authors reviewed the evidence for or against the use of decompressive laminectomy to treat PSI to provide a triservice (US Army, Navy, and Air Force) consensus and treatment recommendations for military neurosurgeons and spine surgeons.Methods. A US National Library of Medicine PubMed database search that identified all literature dealing with acute management of PSI from military conflicts and civilian urban trauma centers in the post-Vietnam War period was undertaken.Results. Nineteen retrospective case series (11 military and 8 civilian) met the study criteria. Eleven military articles covered a 20-year time span that included 782 patients who suffered either gunshot or blast-related projectile wounds. Four papers included sufficient data that analyzed the effectiveness of surgery compared with nonoperative management, 6 papers concluded that surgery was of no benefit, 2 papers indicated that surgery did have a role, and 3 papers made no comment. Eight civilian articles covered a 9-year time span that included 653 patients with spinal gunshot wounds. Two articles lacked any comparative data because of treatment bias. Two papers concluded that decompressive laminectomy had a beneficial role, 1 paper favored the removal of intracanal bullets between T-12 and L-4, and 5 papers indicated that surgery was of no benefit.Conclusions. Based on the authors' military and civilian PubMed literature search, most of the evidence s...

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Section: Historymentioning

confidence: 99%

Section: Historymentioning

confidence: 99%

Section: Historymentioning

confidence: 99%

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Can surgery improve neurological function in penetrating spinal injury? A review of the military and civilian literature and treatment recommendations for military neurosurgeons

Klimo

Ragel

Rosner

et al. 2010

FOC

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“…After reviewing World War I SCIs, the British Medical Research Council concluded that CGSWSCI with progressive neurological deficit was an indication for operative decompression [31]. Later, during World War II, aggressive débridement, decompression, and intradural exploration was the favorable treatment option.…”

Section: Introductionmentioning

confidence: 99%

Civilian Gunshot Injuries of the Spinal Cord: A Systematic Review of the Current Literature

Sidhu

Ghag

Prokuski

et al. 2013

Clinical Orthopaedics &Amp; Related Research

129

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Background The principles that guide management of spinal cord injury (SCI) derive from injury resulting from blunt trauma, not gunshot wounds. Civilian gunshot-induced spinal cord injury (CGSWSCI) is a common, potentially serious cause of neurological deficit; there is disagreement about whether the same approaches used for SCI caused by blunt-force trauma should apply to gunshot-induced SCI. Questions/purposes We reviewed the literature to answer the following questions regarding presentation and outcome of gunshot wound-induced SCI: (1) Are there differences in recovery prognosis between complete SCI and other patterns of SCI in CGSWSCI. (2) Does the use of steroids improve neurological recovery? (3) Does surgery to remove the bullet affect neurological recovery in CGSWSCI? (4) Does surgery result in an increased risk of complications of treatment? Methods We performed a systematic literature review of articles related to civilian gunshot injuries to the spine. Information relating to incidence, pattern of neurological injury, associated injuries, treatment, neurological outcome, and associated complications was extracted. Three independent reviewers assessed the strength of evidence present in the literature by examining quality, quantity, and consistency of results.

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“…Radiographs were available throughout the 20th century, but their scope was limited as only severe spinal fractures could be adequately visualized. 61 Computed tomography was developed in the 1970s, allowing for detailed visualization of osseous structures, and current guidelines for combat casualties require its use for cervical spine clearance. 62 The introduction of MRI in the 1980s transformed the workup of SCI, allowing high-resolution imaging of cord tissue, edema, and ligamentous injury.…”

Section: Modern Military Conflicts (1989-2022)mentioning

confidence: 99%

Advancements in the treatment of traumatic spinal cord injury during military conflicts

Hersh

Davidar

Weber-Levine

et al. 2022

Neurosurgical Focus

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Significant advancements in the treatment of spinal cord injury (SCI) were developed in the setting of military conflicts, partly due to the large numbers of injuries sustained by service members. No effective SCI treatment options existed into the early 20th century, and soldiers who sustained these injuries were usually considered untreatable. Extensive progress was made in SCI treatment during and after World War II, as physical therapy was increasingly encouraged for patients with SCI, multidisciplinary teams oversaw care, pathophysiology was better understood, and strategies were devised to prevent wound infection and pressure sores. Recent conflicts in Iraq and Afghanistan have caused a substantial rise in the proportion of SCIs among causes of casualties and wounds, largely due to new forms of war and weapons, such as improvised explosive devices. Modern military SCIs resulting from blast mechanisms are substantively different from traumatic SCIs sustained by civilians. The treatment paradigms developed over the past 100 years have increased survival rates and outcomes of soldiers with SCI. In this paper, the authors review the role of military conflicts in the development of therapeutic interventions for SCI and discuss how these interventions have improved outcomes for soldiers and civilians alike.

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Compound Injuries of the Spinal Cord

Cited by 21 publications

References 1 publication

Can surgery improve neurological function in penetrating spinal injury? A review of the military and civilian literature and treatment recommendations for military neurosurgeons

Can surgery improve neurological function in penetrating spinal injury? A review of the military and civilian literature and treatment recommendations for military neurosurgeons

Civilian Gunshot Injuries of the Spinal Cord: A Systematic Review of the Current Literature

Advancements in the treatment of traumatic spinal cord injury during military conflicts

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