Treatment Of Acute Spinal Injury Research Articles

Effects of short-segment pedicle screw internal fixation surgery combined with hyperbaric oxygen treatment for acute spinal injury on the morphology and function of the spine

To explore effect of short-segment pedicle screw internal fixation combined with hyperbaric oxygen in treating acute spinal fractures and its influence on recovery of spinal nerve function. A total of 96 patients with acute spinal fracture admitted from February 2017 to March 2020 were divided into combined group and control group, with 48 cases in each group. Both groups were treated with short-segment pedicle screw internal fixation. The combined group was given hyperbaric oxygen after surgery. The operation time, surgical blood loss, incision length and other general operation conditions between two groups were recorded. The differences in spinal morphology and function, Ameraican Spinal Injury Assiciation(ASIA) neurological function grade, serum inflammatory factors and ability of daily living activities were observed before and after surgery. There was no significant difference in operation time, surgical blood loss, and incision length between combined group and control group(P>0.05). There were no significant differences in anterior height ratio and Cobb angle between two groups before surgery, 1 week and 6 months after surgery(P>0.05). The height ratio of anterior margin of the injured spine was significantly improved in both groups at 1 week and 6 months after surgery compared with preoperative period (P<0.05), and Cobb angle was significantly reduced in both groups compared with preoperative period (P<0.05). There was no statistically significant difference in serum interleukin-6(IL-6), interleukin-8(IL-8), and tumor necrosis factor-α(TNF-α) levels between two groups at 1 d after surgery(P>0.05);the serum IL-6, IL-8, and TNF-α levels of combined group were lower than those of control group at 1 week after surgery (P<0.05). At 6 months after surgery, ASIA neurological function grade of combined group was C grade in 2 cases, D grade in 23 cases, E grade in 22 cases. In control group, 7 cases was grade C, 26 cases was grade D, 13 cases was grade E, and the difference between two groups was statistically significant(P<0.05). The Barthel score of combined group was higher than that of control group at 1 month and 3 months after surgery, and the difference was statistically significant (P<0.05);at 6 months after surgery, there was no significant difference in Barthel score between two groups(P>0.05). Short-segment pedicle screw internal fixation combined with hyperbaric oxygen for the treatment of acute spinal fractures is beneficial to the recovery of spinal nerve function after surgery, and has a certain effect on the early improvement of the patients' activities of daily living.

The incidence and characterisation of hospitalised acute spinal trauma in Taiwan—A population-based study

The purpose of this study was to perform a cross-sectional population-based study of hospitalised cases due to acute spinal trauma in Taiwan, based on information from the nationwide National Health Insurance (NHI) database. To calculate the annual incidence of hospitalised acute spinal trauma, evaluate the distribution of neurological injury and its surgical intervention, and analyse the use of medical resources and related factors in Taiwan, the entire inpatient datasets were selected between 2000 and 2003 for use in the present study. There were 13,371, 13,800, 13,728 and 13,585 cases identified in 2000, 2001, 2002 and 2003, respectively, the average incidence of hospitalised acute spinal trauma in Taiwan was 61.61/100,000, and it was similar in both genders (rate ratio of male to female: 0.99). There was a significant trend of increased incidence with increasing age in both genders, particularly after the age of 60. The decreasing incidence rate ratios of neurological deficit to neurological intactness are 0.75, 0.58, 0.45, 0.26 and 0.16 in the age strata of 0-19, 20-39, 40-59, 60-79 and 80 or more years, respectively. In general, the operation rate is only 17.3% of all acute spinal injury cases, but it would be up to a significant 29.5% if the patients had spinal fractures with neurological insufficiency. There is an obvious decreasing trend of operation rate in spinal bony trauma with age, but a reverse trend is noted in the group with spinal nerve injury without spinal fracture. Finally, the enrolled subjects of acute spinal injuries spent $NT 43336.3+/-80270.2 (equal to US$ 1313+/-2432) and stayed for 8.5+/-8.9 days in hospital. The above two variables of hospitalised medical utilisation are significantly different when considering gender, neurological status, and surgical intervention or not. Noticeably, if operative treatment for acute spinal injury is necessary, the LOS would increase by two times and the medical cost by six times. In Taiwan, the annual incidence of hospitalised acute spinal injuries was higher but the direct cost was much lower. The characterisation of gender ratio, neurological condition, and surgical performance had been significantly effected by age.

MR imaging of penetrating spinal trauma.

T he goals of treatment of acute spinal injury after penetrating trauma are to ensure stability of the spine, to minimize the extent of neurologic deficit, and to prevent further loss of neurologic function. MR imaging directly reveals the spinal cord parenchyma so that the radiologist can detect missile tracts, contusions, and hematomas resulting from direct cord penetration and indirect concussion effects from proximity high-velocity missile injuries. In addition, MR imaging can reveal cord compre ssion from extramedullary sources including hematoma, displaced bone or bullet fragments. and pseudomeningocele. Injuries to the spinal ligaments and vertebral arteries can also be seen on MR imaging F1 . 21. This pictorial essay reviews the spectrum of MR imaging pathology found with penetrating spinal injuries and discusses the influence of MR findings on patient treatment.

Effet de l'administration continue de nimodipine à la phase aiguë d'un traumatisme médullaire chez le babouin

This study was carried out to assess the putative improvement of spinal cord blood flow obtained with a calcium channel blocker after acute spinal cord injury in ten baboons. The injury was generated by compressing the cord at L1 level for 5 seconds with a balloon catheter inflated to 2 bars with Ringer's solution. Subsequently, five monkeys received a saline infusion, and five others a nimodipine infusion (0.04 mg · kg −1 · h −1), for seven days. Spinal cord blood flow (SCBF) was measured using a scanographic technique with stable xenon. Somatosensory evoked potentials (SEP), magnetic resonance imaging (MRI) and a histological study of the spine were carried out a different times of the study. SCBF and SEP were recorded before injury. Thereafter SCBF was measured every thirty minutes during the four hours following the injury, as well as on day 7. SEP and MRI were recorded on days 1 and 7. The histological study was carried out on the eighth day. Three spinal cord and vertebral segments were collected, fixed, sliced and stained. SCBF before injury was not significantly different in either group (39.8 ± 15.9 ml · 100 g −1 · min −1 for the treatment group vs 40.9 ± 16.3 ml · 100 g −1 · min −1 for the control group). During the injury, there were major variations between animals. The results were expressed as percentages of each animal's control SCBF (before injury). Immediately after injury, SCBF increased in both groups. However, in the control group, SCBF decreased more than in the treatment group on the seventh day after injury (80 to 90 % vs 25 to 50 %, respectively). In two of the treated animals, a wave was recorded on the eighth day. This wave, although not corresponding to a typical SEP wave, was not an artefact. There were no significant MRI differences in the size of the lesion between the two groups, although histological studies showed a smaller lesion in the treated group : 45.2 ± 6.1 mm vs 26.4 ± 4.3 mm (white matter), and 31.6 ± 3.1 mm vs 14.0 ± 4.3 mm (grey matter) in the control and treated groups respectively. It is concluded that nimodipine improves SCBF, reduces the size of the spinal cord injury, and is likely to improve functional recovery. This drug could well become part of the treatment of acute spinal injury in man in the future. However its clinical value remains to be assessed.

Complications in the Treatment of Acute Spinal Injury

Complications may occur during any phase of the treatment process for acute spinal injuries. An awareness of the most common problems is the most powerful tool that the physician has to prevent him or her from repeating at least some of the errors of others.