Effect of Timing of Stabilization on Length of Stay and Medical Complications Following Spinal Cord Injury

Campagnolo, Denise I.; Esquieres, Raymond; Kopacz, Kenneth

doi:10.1080/10790268.1997.11719484

Cited by 45 publications

(19 citation statements)

References 6 publications

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“…In fact, the relationship between the time spent in the neurosurgery ward, a vertebral osteosynthesis and the length of immobilization time have already been described for the patient with SCI, and it seems that the sooner the patient is surgically stable, the shorter will be the hospital stay and immobilization time. 52,53 Performing a tracheotomy should probably not be regarded as a risk factor per se, but rather as a marker for the severity of the patient's clinical state. Other therapeutic actions, such as wearing a neck brace during the acute stage of polytrauma, have been associated with the onset of PU, 54 but no study is SCI-specific for this variable.…”

Section: Discussionmentioning

confidence: 99%

Pressure ulcer risk factors in persons with SCI: part I: acute and rehabilitation stages

Gélis

Dupeyron

Legros³

et al. 2008

Spinal Cord

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Background: Pressure ulcers (PUs) are a common complication following a spinal-cord injury (SCI). Good prevention requires identifying the individuals at risk for developing PUs. Risk assessment scales used nowadays were designed on pathophysiological concepts and are not SCI-specific. Recently, an epidemiological approach to PU risk factors has been proposed to design an SCI-specific assessment tool. The first results seem quite disappointing, probably becuase of the level of evidence of the risk factors used. Objective: To determine PU risk factors correlated to the patients with SCI, medical care management during the acute as well as in the rehabilitation and chronic stages. This first part focuses on identifying the risk factors during the acute and rehabilitation stages. Materials and methods: Systematic review of the literature. Results: Six studies met our inclusion criteria. The risk factors during the acute stage of an SCI are essentially linked to care management and treatment modalities. There is insufficient evidence to make a recommendation on medical risk factors, except for low blood pressure on admission to the Emergency Room, with a moderate level of evidence. Regarding the rehabilitation stage, no study was deemed relevant. Discussion and conclusions: Additional observational studies are needed, for both the acute and rehabilitation stages, to improve this level of evidence. However, this systematic review unveiled the need for a carefully assessed t care management and the related practices, especially during the acute stage of an SCI.

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Section: Discussionmentioning

confidence: 99%

Pressure ulcer risk factors in persons with SCI: part I: acute and rehabilitation stages

Gélis

Dupeyron

Legros³

et al. 2008

Spinal Cord

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“…Four studies [7,36,37,41] reported no difference in the rate of medical complications between the early and late surgical groups, whereas four studies found overall fewer complications in the persons receiving early surgical decompression. Specifically, Mirza et al [42] reported fewer complications in persons receiving surgery within 72 hours of injury; Croce et al [16] reported lower rates of pneumonia and DVT in persons receiving surgery within 24 hours; Chipman et al [14] reported a lower frequency of all complications in patients with an Injury Severity Score (ISS) greater than 15 and receiving surgery within 72 hours of injury (although this same group reports equal medical complications in persons with low ISS [less than 15] regardless of the time of decompression); McKinley et al [40] report higher rates of pneumonia in the late surgery group but equal rates of other complications (DVT, pulmonary embolism, ulcers).…”

Section: Histopathologic Correlationmentioning

confidence: 98%

“…Of the 22 clinical studies identified in this review, nine Level III studies measured the length of stay [7,11,14,16,27,32,37,40,42,52]. Early surgical decompression was associated with a shorter hospital length of stay in eight studies [7,14,16,27,32,37,40,42] (although Guest et al [27] reported no p values), whereas the other only recorded the length of stay in the ICU [52]. A subset of these studies further divided overall length of stay with the duration of stay in the ICU [14,16,27,32] and found this time point was also less in patients receiving early decompressive surgery.…”

Section: Histopathologic Correlationmentioning

confidence: 99%

Spinal Cord Injury: A Systematic Review of Current Treatment Options

Cadotte

Fehlings

2011

Clinical Orthopaedics &Amp; Related Research

117

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Background Spinal cord injury (SCI) is a devastating event often resulting in permanent neurologic deficit. Research has revealed an understanding of mechanisms that occur after the primary injury and contribute to functional loss. By targeting these secondary mechanisms of injury, clinicians may be able to offer improved recovery after SCI. Questions/purposes In this review, we highlight advances in the field of SCI by framing three questions: (1) What is the preclinical evidence for the neuroprotective agent riluzole that has allowed this agent to move into clinical trials? (2) What is the preclinical evidence for Rho antagonists that have allowed this group of compounds to move into clinical trials? (3) What is the evidence for early surgical decompression after SCI?Methods We conducted a systematic review of MEDLINE and EMBASE-cited articles related to SCI to address these questions.

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“…If significant functional recovery has not emerged by 6 months after injury, the probability of major improvement beyond this time point diminishes considerably (46)(47)(48)(49). Surgical treatment of the fracture is common (13,14,(50)(51)(52)(53), but at the present, attempts to repair damaged nerve roots (5,16,17) or the spinal cord (18) in humans are rare.…”

Section: Discussionmentioning

confidence: 99%

A Guidance Channel Seeded With Autologous Schwann Cells for Repair of Cauda Equina Injury in a Primate Model

Calancie

Madsen

Wood

et al. 2009

The Journal of Spinal Cord Medicine

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Background/Objective: To evaluate an implantable guidance channel (GC) seeded with autologous Schwann cells to promote regeneration of transected spinal nerve root axons in a primate model. Methods: Schwann cells were obtained from sural nerve segments of monkeys (Macaca fascicularis; cynomolgus). Cells were cultured, purified, and seeded into a PAN/PVC GC. Approximately 3 weeks later, monkeys underwent laminectomy and dural opening. Nerve roots of the L4 through L7 segments were identified visually. The threshold voltage needed to elicit hindlimb muscle electromyography (EMG) after stimulation of intact nerve roots was determined. Segments of 2 or 3 nerve roots (each ;8-15 mm in length) were excised. The GC containing Schwann cells was implanted between the proximal and distal stumps of these nerve roots and attached to the stumps with suture. Follow-up evaluation was conducted on 3 animals, with survival times of 9 to 14 months. Results: Upon reexposure of the implant site, subdural nerve root adhesions were noted in all 3 animals. Several of the implanted GC had collapsed and were characterized by thin strands of connective tissue attached to either end. In contrast, 3 of the 8 implanted GC were intact and had white, glossy cables entering and exiting the conduits. Electrical stimulation of the tissue cable in each of these 3 cases led to low-threshold evoked EMG responses, suggesting that muscles had been reinnervated by axons regenerating through the repair site and into the distal nerve stump. During harvesting of the GC implant, sharp transection led to spontaneous EMG in the same 3 roots showing a low threshold to electrical stimulation, whereas no EMG was seen when harvesting nerve roots with high thresholds to elicit EMG. Histology confirmed large numbers of myelinated axons at the midpoint of 2 GC judged to have reinnervated target muscles. Conclusions: We found a modest rate of successful regeneration and muscle reinnervation after treatment of nerve root transection with a Schwann cell-seeded, implanted synthetic GC. Newer treatments, which include the use of absorbable polymers, neurotrophins, and antiscar agents, may further improve spinal nerve regeneration for repair of cauda equina injury.

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Effect of Timing of Stabilization on Length of Stay and Medical Complications Following Spinal Cord Injury

Cited by 45 publications

References 6 publications

Pressure ulcer risk factors in persons with SCI: part I: acute and rehabilitation stages

Pressure ulcer risk factors in persons with SCI: part I: acute and rehabilitation stages

Spinal Cord Injury: A Systematic Review of Current Treatment Options

A Guidance Channel Seeded With Autologous Schwann Cells for Repair of Cauda Equina Injury in a Primate Model

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