Timing of Surgery Following Spinal Cord Injury

Study DesignProspective, cross-sectional, observational study.PurposeSpine traumata are devastating injuries, which may result in serious disabilities and dire consequences. The current study involves a detailed analysis and description of patients, who were operated at a tertiary care, urban level 1 Spine Centre in India.Overview of LiteratureVarious studies in literature have discussed the epidemiology and patterns of these injuries in trauma patients. However, literature describing the demographic profile and distribution of these traumata in the Indian population is scarce.MethodsThe current study was conducted as a prospective trial involving patients, who were treated at our Spine Centre in India between July 2009 to December 2012. We studied 92 patients with thoraco-lumbar spine fracture, who were operated with short or long segment posterior stabilization. Epidemiological details, pre- and post-hospitalisation care received and other injury pattern factors were studied.ResultsFall from height (46 patients, 50%) was the most common mechanism observed in the patients. Sixty-three percent injuries belonged to AO type A fractures, while 16.2% and 19.4% of the patients had suffered from AO types B and C injuries, respectively.ConclusionsWe identified interesting epidemiological data and prevailing inadequacies in Emergency Spine care management in the study patients. These observations could facilitate implementation of the changes required to improve current standards of patient care.

show abstract

“…Delay in presentation to a well-equipped spine centre is another concern [181920]. In the UK, the average delay is estimated at 5.5 days [5].…”

Section: Discussionmentioning

confidence: 99%

Demographics of Thoracolumbar Fracture in Indian Population Presenting to a Tertiary Level Trauma Centre

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Adult people are the active age group of any community, which makes them more susceptible for spinal cord injuries. The mean ages of patients of SCI reported are from 30.9 years - 38.9 years from various series 26101112…”

Section: Discussionmentioning

confidence: 99%

“…In Nigeria, there is delay of seven days in presentation of spinal injured patients to a spinal unit 8. Early presentation of spinal injured patients to a spinal unit enables early surgery, which is beneficial in terms of reducing complications, length of stay and hospital cost 6. Scivoletto4 concluded that spinal injured patients presenting early at spinal unit show better functional outcome after rehabilitation than patients presenting late.…”

Section: Discussionmentioning

confidence: 99%

“…However, inadequate precautions during transportation can cause further injury to the already compromised spinal cord in spinal injured patients 23. Early surgery and comprehensive rehabilitation markedly reduces the overall morbidity of spinal cord injured patients by enabling the patient to lead an independent life 4–6. The tertiary, regional spinal centers with the assembly of specialized trained personnel and specialized technology to provide a comprehensive rehabilitation.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Care of post-traumatic spinal cord injury patients in India: An analysis

et al. 2007

View full text Add to dashboard Cite

Background:The spinal cord injured patients if congregated early in spinal units where better facilities and dedicated expert care exist the outcome of treatment and rehabilitation, can be improved. The objective of this study is to find out the various factors responsible for a delay in the presentation of spinal injury patients to the specialized spinal trauma units and to suggest steps to improve the quality of care of the spinal trauma patients in the Indian setup.Materials and Methods:Sixty patients of traumatic spinal cord injury admitted for rehabilitation between August 2005 and May 2006 were enrolled into the study and their data was analyzed.Results:Eighty-five per cent of the spinal cord injured patients were males and the mean age was 34 years (range 13-56 years). Twenty-nine (48.33%) of the spinal injuries occurred due to fall from height. There was an average of 45 days (range 0-188 days) of delay in presentation to a specialized spinal unit and most of the time the cause for the delay was unawareness on the part of patients and/or doctors regarding specialized spinal units. In 38 (62.5%) cases the mode of transportation of the spinal cord injured patient to the first visited hospital was by their own conveyance and the attendants of the patients did not have any idea about precautions essential to prevent neurological deterioration. Seventeen (28.33%) patients were given injection solumedrol with conservative treatment, 35 (60%) patients were given only conservative treatment and seven patients were operated (11.66%) upon at initially visited hospital. Of the seven patients operated five were fixed with posterior Harrington instrumentation (71.42%) and two (28.57%) were operated by short segment posterior pedicle screw fixation. None of the patients were subjected to physiotherapy-assisted transfers or wheel chair skills or even basic postural training, proper bladder/ bowel training program and sitting balance.Conclusion:Awareness on the part of the general population, attendants of the patients, clinical and paraclinical team regarding spinal cord injury needs to be addressed. Safe mode of transportation of spinal cord injured patient and early presentation at tertiary spinal care center with comprehensive spinal trauma care team should be stressed upon.

show abstract

“…However, acute spinal cord injury involves primary and secondary mechanisms of injury 18. While efforts are taken to reduce primary injury,19,20 steps are also taken to prevent the secondary injury resulting from changes in the tissues and the circulation 6,21…”

Section: Discussionmentioning

confidence: 99%

Neuropathic pain as a process: reversal of chronification in an animal model

Dableh

Yashpal²,

Henry

2011

JPR

View full text Add to dashboard Cite

Peripheral neuropathic pain arises from trauma to sensory nerves. Other types of acute neurotrauma such as stroke and spinal cord injury are treated immediately, largely to prevent secondary damage. To pursue the possibility that neuropathic pain may also be amenable to early treatment, a rat model of neuropathic pain was induced using a 2-mm polyethylene cuff implanted around one sciatic nerve. Within 24 hours, hypersensitivity to von Frey hair stimulation appeared, as indicated by decreased paw withdrawal thresholds. When the cuff was removed 24 hours after implantation, readings returned to pre-implantation levels starting as early as day 18. When the cuff was removed after 4 days, there was a period of initial hypersensitivity, and then an increase toward baseline at two time points near the end of the study; therefore, only a partial recovery toward pre-implantation values occurred. Having established that a temporal reversal can occur, the next step examined possible pharmacological reversal. The tachykinin NK1 receptor antagonist, CP-96,345, produced a minor increase in withdrawal thresholds in animals with the cuff left permanently implanted. To determine the effect of early and repeated administration of CP-96,345, it was given daily on days 1–4. The cuff was removed on day 4. Six days later, readings showed reversal of tactile hypersensitivity. We suggest that persistent neuropathic pain occurs from processes that develop over several hours and days, and that some of these processes may be prevented by early medical intervention. Thus, nerve injury in the context of chronic neuropathic pain should be treated in a similar manner to nerve injury resulting from stroke, spinal cord injury, and other types of neurotrauma. We suggest that effective medical intervention within the first few hours after nerve injury may spare a patient from a chronic debilitating pain that may be refractory to later therapies.

show abstract

Timing of Surgery Following Spinal Cord Injury

Cited by 27 publications

References 52 publications

Demographics of Thoracolumbar Fracture in Indian Population Presenting to a Tertiary Level Trauma Centre

Demographics of Thoracolumbar Fracture in Indian Population Presenting to a Tertiary Level Trauma Centre

Care of post-traumatic spinal cord injury patients in India: An analysis

Neuropathic pain as a process: reversal of chronification in an animal model

Contact Info

Product

Resources

About