Risk Of Cord Injury Research Articles

Young people’s safety beliefs after a spinal cord injury health promotion and awareness presentation

Objective: Adolescence is presented as a vulnerable period for accidental injury, particularly spinal cord injury, given young people’s propensity for risky behaviours. School-based health promotion initiatives provide opportunities for education about the risks associated with dangerous behaviours. In this study, we aimed to describe young people’s safety beliefs before and after a school-based spinal cord health promotion and awareness presentation. The effect of selected demographic characteristics on safety beliefs was also examined. Design: A pre–post design was used to record group and time point differences on a range of specific safety beliefs before and after the presentation. Setting and method: The Spinal Education and Awareness Team (SEAT) from Spinal Life Australia conducted a health promotion and awareness presentation with 1,410 students aged 14–19 years across 13 secondary schools in Queensland, Australia. Presentations took place in regional, metropolitan and provincial city schools. A survey assessing basic demographic characteristics and specific risk behaviours was completed by students before and after the presentation. Results: T-tests and chi-square analyses were conducted to examine time point and group differences in relation to the SEAT presentation and to determine relative risks between subgroups of young people. A total of 705 pre-surveys (50%) and 735 post-surveys (52%) were analysed. Overall, reported beliefs were significantly safer post-presentation compared to pre-presentation (all t > 6.93, p < .001). Rural adolescent boys licensed to drive emerged as a particularly risky sub-group and were over three times (odds ratio [OR] = 3.35, 95% confidence interval [CI] = 1.34, 8.40) more likely than their metropolitan peers to hold less safe beliefs relating to spinal cord injury. Conclusion: Findings indicated that the health promotion and awareness presentation increased awareness of spinal cord injury risk behaviours overall and improved adolescent-related safety beliefs. Licensed adolescent boys from rural areas reported little change in awareness post-presentation, further highlighting the importance of targeted health promotion initiatives in rural areas. Extended research is required to further explore the belief–behaviour interaction in this at-risk population.

Torg’s ratio in normal adult nepalese population

Introduction: Acute cervical trauma occasionally leads to cervical canal stenosis in some individuals in spite of minor trauma. The spinal canal-to-vertebral body ratio (Torg-Pavlov ratio) has been proposed for assessing developmental spinal canal stenosis. It is not affected by magnification, and is measured on lateral plain films of cervical vertebrae. The result of this study may help in better understanding of the Torg’s ratio, which is more reliable than direct measuring of the mid-sagittal diameter of the cervical spinal canal in the diagnosis of cervical spinal stenosis or predicting the prognosis of cervical spinal cord injury. If Torg’s ratio is below normal there is risk of cervical cord injury whereas relatively safe in large Torg’s ratio. Torg’s ratio can be accessed even in rural areas where x-rays are easily available and more economical than MRI and CT scan. It can assess the risk of cord injury during sports and outdoor activities and help individuals’ choose safe carrier in sports or others activities.Methods: In order to ascertain the normal values of the Torg’s ratio in adults Nepalese, hundred sets of cervical vertebral columns of hundred adult Nepalese population of age group 20-40 years were examined. Consecutive patients presenting with history of neck pain with normal x-ray findings or history of trauma without cervical spine injury from Orthopaedic OPD (out patients department) and emergency department of Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu from March 2011 to August 2012 were included in the study.Results: There were 48 males and 52 females with age ranging from 20 yrs to 40 yrs with the mean of 30.34±5.36 years. The normal average canal/body ratio of the cervical spine is 0.99 +/- 0.09 in male and 1.01 +/- 0.07 in female. It was observed that the ratio of the antero-posterior diameters of cervical spinal canal and vertebral bodies showed sexual dimorphism.Conclusion: The Torg’s ratio is the same irrespective of gender and height. The result of this study will help in better understanding of the Torg’s ratio, which is more reliable than direct measuring of the mid-sagittal diameter of the cervical spinal canal in the diagnosis of cervical spinal stenosis or predicting the prognosis of cervical spinal cord injury.JSSN 2015; 18 (1), Page: 5-9

Cervical spinal canal stenosis first presenting after spinal cord injury due to minor trauma: An insight into the value of preventive decompression

Patients with pre-existing cervical spinal canal stenosis (CSCS) may have minimal or no symptoms. However, performing preventive decompression is controversial as the incidence of CSCS leading to severe cord injury is unknown. Hence, this study aims to revisit the threshold for surgery in "silent" CSCS by reviewing the neurologic outcomes of patients with undiagnosed CSCS who sustained a cervical spinal cord injury (CSCI). Two groups of subjects were recruited for analysis. Firstly, patients with trauma-induced CSCI without fracture or dislocation were included. Pre-existing CSCS was diagnosed by MRI measurements. The second group consisted of asymptomatic subjects recruited from the general population who also had MRIs performed. Canal sizes were compared between this control group and the patient group. Within the patient group, neurological assessments and outcomes by Frankel classification were performed in patients treated surgically or conservatively. 32 patients with CSCS were recruited. The mean spinal canal sagittal diameter (disc-level) of all CSCS cases was 5.3±1.4mm (1.3-8.2). In comparison, the diameter was 10.5±1.7mm (6.6-14.6) in the 47 asymptomatic individuals recruited from the general population. Decompression was performed in 17 patients and conservative treatment in 15. Mean follow-up was 19.3±17.0 months (6-84). At the final follow-up, 3 patients (9.3%) returned to their pre-injury Frankel grade, whereas 26 patients (83.3%) lost one or more neurological grade. Three patients (9.3%) died. Majority of patients with "silent" CSCS who sustained cervical cord injuries did not return to their pre-injury neurological status. All of these subjects have pre-existing canal stenosis hence the risk of cord injury. Given the poor neurological outcome of CSCS, a lower threshold for surgery could be indicated to avoid these disastrous injuries. However, before making any conclusive recommendation we must first identify the prevalence of "silent" CSCS in the general population and the risk of developing spinal cord injury with more prospective population-based studies.

Tolerance of the human spinal cord to high energy P(66)Be(49) neutrons

The risk of post irradiation myelopathy was evaluated in 76 patients followed for 1–5 years after neutron irradiation of the cervical and thoracic regions. No overt myelopathy was observed. Forty-six patients received doses (central cord dose) in excess of 10 Gy, 9 received doses in excess of 12 Gy, and 5 received doses between 13 and 17 Gy, all without any evidence of spinal cord injury. On careful questioning, a subjective transient neuropathy (a tingling sensation in one extremity) was reported by 6 patients, but this was apparently unrelated to dose. A review of available literature revealed a total of 14 patients with myelopathy, 13 of whom received doses in excess of 13 Gy delivered with relatively low energy neutrons generated by the deuteron + beryllium reaction. It is concluded from these studies that the tolerance limit for the human spinal cord irradiated with high energy [p(66)Be(49)] neutrons is close to 15 Gy, above which the risk of cord injury becomes significant. Central cord doses of 13 Gy or less appear to be well tolerated with little, if any, risk of myelopathy. These conclusions are valid for a treatment time of 4 weeks or more with two or more fractions per week (9 or more fractions). The RBE for the human spinal cord irradiated under the above conditions compared with conventionally fractionated photon therapy does not exceed 4.0.