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Emergency,spine trauma,acute spinal cord injury

Thomas M Kessler, Luca R Traini, Blayne Welk, Marc P Schneider, Jeffrey Thavaseelan, Armin Curt
PURPOSE: Considering the major clinical challenges of managing patients with spinal cord injury (SCI), we summarized the relevant aspects of the early (within 1 year after SCI) neurological care emphasizing common standards. METHODS: This review was performed according to the methodology recommended by the Joint SIU-ICUD International Consultation. Embase and Medline databases were used to identify literature relevant to the early neurological care of SCI patients...
October 2018: World Journal of Urology
Michael J McGinity, Ramesh Grandhi, Joel E Michalek, Jesse S Rodriguez, Aron M Trevino, Ashley C McGinity, Ali Seifi
BACKGROUND: Recent interest in the study of concussion and other neurological injuries has heightened awareness of the medical implications of American tackle football injuries amongst the public. OBJECTIVE: Using the National Emergency Department Sample (NEDS) and the National Inpatient Sample (NIS), the largest publicly available all-payer emergency department and inpatient healthcare databases in the United States, we sought to describe the impact of tackle football injuries on the American healthcare system by delineating injuries, specifically neurological in nature, suffered as a consequence of tackle football between 2010 and 2013...
2018: PloS One
Gautam Zaveri, Gurdip Das
Sub-axial cervical spine injuries are commonly seen in patients with blunt trauma. They may be associated with spinal cord injury resulting in tetraplegia and severe permanent disability. Immobilization of the neck, maintenance of blood pressure and oxygenation, rapid clinical and radiological assessment of all injuries, and realignment of the spinal column are the key steps in the emergency management of these injuries. The role of intravenous methylprednisolone administration in acute spinal cord injuries remains controversial...
November 2017: Indian Journal of Orthopaedics
Hang Xian, Li-Wei Xu, Cong-Han Li, Jian-Ming Hao, Wei-Xia Wan, Guo-Dong Feng, Ke-Jian Lian, Lin Li
RATIONALE: Spontaneous spinal epidural hematoma (SSEH) is a relatively rare but potentially disabling disease, and the classical presentation of it includes an acute onset of severe, sometimes radiating back or neck pain, followed by signs and symptoms of rapidly evolving nerve root or spinal cord compression. PATIENT CONCERNS: Here, we report a 26-year-old female patient presented with weakness in bilateral lower extremities, progressing to intense paraplegia and anesthesia without recent medical history of trauma, infection, surgery, or drug use...
November 2017: Medicine (Baltimore)
Marc A Childress
There are a variety of causes of neck pain, including trauma and degenerative changes. The history of onset helps to direct evaluation, including the need for imaging or ancillary testing. Patterns of pain, weakness, and other specific physical examination findings also aid in diagnosis. Management of most soft tissue injuries involves early mobilization, whereas fractures are managed based on patterns of instability. Acute spinal cord injury requires emergent care, to include possible decompressive surgery...
October 2017: FP Essentials
Lucas Oliveira J E Silva, M Fernanda Bellolio, Elisa M Smith, David J Daniels, Christine M Lohse, Ronna L Campbell
BACKGROUND: Motor vehicle-related injuries (including off-road) are the leading cause of traumatic brain injury (TBI) and acute traumatic spinal cord injury in the United States. OBJECTIVES: To describe motocross-related head and spine injuries of adult patients presenting to an academic emergency department (ED). METHODS: We performed an observational cohort study of adult ED patients evaluated for motocross-related injuries from 2010 through 2015...
October 2017: American Journal of Emergency Medicine
Christopher P Michetti, Heather A Prentice, Jennifer Rodriguez, Anna Newcomb
BACKGROUND: We studied trauma-specific conditions precluding semiupright positioning and other nonmodifiable risk factors for their influence on ventilator-associated pneumonia (VAP). METHODS: We performed a retrospective study at a Level I trauma center from 2008 to 2012 on ICU patients aged ≥15, who were intubated for more than 2 days. Using backward logistic regression, a composite of 4 factors (open abdomen, acute spinal cord injury, spine fracture, spine surgery) that preclude semiupright positioning (supine composite) and other variables were analyzed...
February 2017: American Journal of Surgery
Yogesh Kumar, Daichi Hayashi
Magnetic resonance imaging (MRI) has been playing an increasingly important role in the spinal trauma patients due to high sensitivity for detection of acute soft tissue and cord injuries. More and more patients are undergoing MRI for spinal trauma in the emergency settings, thus necessitating the interpreting physicians to be familiar with MRI findings in spinal trauma. In this pictorial review, we will first describe the normal anatomy of various ligamentous structures. Indications of MRI in spinal trauma as well as the role of MRI in diagnosing spinal cord and soft tissue injuries will then be discussed...
July 22, 2016: BMC Musculoskeletal Disorders
Christopher S Ahuja, Allan R Martin, Michael Fehlings
Traumatic spinal cord injuries (SCIs) affect 1.3 million North Americans, producing devastating physical, social, and vocational impairment. Pathophysiologically, the initial mechanical trauma is followed by a significant secondary injury which includes local ischemia, pro-apoptotic signaling, release of cytotoxic factors, and inflammatory cell infiltration. Expedient delivery of medical and surgical care during this critical period can improve long-term functional outcomes, engendering the concept of "Time is Spine"...
2016: F1000Research
Roy Riascos, Eliana Bonfante, Claudia Cotes, Mary Guirguis, Reza Hakimelahi, Clark West
Approximately one-third of all cervical spine injuries involve the craniocervical junction (CCJ). Composed of the occiput and the first two cervical vertebrae, this important anatomic landmark, in conjunction with an intricate ligamentous complex, is essential to maintaining the stability of the cervical spine. The atlantoaxial joint is the most mobile portion of the spine, predominantly relying on the ligamentous framework for stability at that level. As acute onsite management of trauma patients continues to improve, CCJ injuries, which often lead to death onsite where the injury occurred, are increasingly being encountered in the emergency department...
November 2015: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Sang Ku Jung, Hyung Jin Shin, Hui Dong Kang, Se Hyun Oh
Acute traumatic central cord syndrome is commonly associated with major trauma such as falling and motor vehicle crash, but minor or nontraumatic causes are very rare in children. As a consequence, most physicians frequently overlook children presenting with complaints of arm weakness when history of any definite major trauma does not exist, especially in the emergency department. We present the case of a 7-year-old boy who was experiencing weakness in both arms after a standing high jump with tilting his head back in school...
September 2014: Pediatric Emergency Care
Harald Wolf, Christoph Krall, Gholam Pajenda, Johannes Leitgeb, Adam J Bukaty, Stefan Hajdu, Kambiz Sarahrudi
BACKGROUND CONTEXT: Although several publications concerning the use of the biomarkers S100B and neuron-specific enolase (NSE) in vertebral spine fractures in animal experimental studies have proven their usefulness as early indicators of injury severity, there are no clinical reports on their effectiveness as indicators in patients with spinal injuries. As these biomarkers have been examined, with promising results, in patients with traumatic brain injury, there is a potential for their implementation in patients with vertebral spine fractures...
December 1, 2014: Spine Journal: Official Journal of the North American Spine Society
Seong Son, Sang Gu Lee, Chan Woo Park, Woo Kyung Kim
We present a case of acute hydrocephalus secondary to cervical spinal cord injury in a patient with diffuse ossification of the posterior longitudinal ligament (OPLL). A 75-year-old male patient visited the emergency department with tetraparesis and spinal shock. Imaging studies showed cervical spinal cord injury with hemorrhage and diffuse OPLL from C1 to C4. We performed decompressive laminectomy and occipitocervical fusion. Two days after surgery, his mental status had deteriorated to drowsiness with dilatation of the right pupil...
August 2013: Journal of Korean Neurosurgical Society
Javier Pizones, Ernesto Castillo
Acute thoracolumbar fractures are commonly diagnosed by clinical symptoms and X-ray plain films. Computed tomography (CT) is used to assess vertebral body damage, posterior wall canal intrusion, and posterior column injury. Both of these imaging tools have helped to develop classifications systems that aid the clinician in differentiating stable versus unstable spinal injuries. Multidetector CT has become the standard of care in polytrauma patients. It provides superior evaluation of bony anatomy and has been reported to be more cost effective than X-ray plain films, particularly in the cervicothoracic junction and in thoracolumbar unstable burst fractures...
September 2013: Seminars in Musculoskeletal Radiology
Julio C Furlan, Kayee Tung, Michael G Fehlings
Prior pre-clinical and clinical studies indicate that early decompression of the spinal cord (≤ 24 h post-trauma) may have benefits regarding clinical outcomes and neurological recovery after spinal cord injury (SCI). This study examines the benchmarking of management of patients with acute traumatic cervical SCI in order to determine the potential barriers and ideal timelines for each step to early surgical decompression. We reviewed patient charts and the Surgical Trial in Acute Spinal Cord Injury Study (STASCIS) forms regarding the time and reasons for delay of each step in the management of patients with SCI...
March 15, 2013: Journal of Neurotrauma
G N Dorovskikh, S A Kozhedub, A Iu Gorlina, S S Sedel'nikov, D A Sulim
The radiation examination of 728 victims of acute spinal column and cord injuries, admitted to Omsk City Emergency Medicine Hospital One in the period 2008-2011, was analyzed. The main cause of spinal column injuries was catastrophe (68.7%), vehicle-related trauma (22.3%), and others (9%). Injuries to the cervical segments of the spinal cord constituted 10.5%. The 5th and 6th cervical vertebrae were most commonly damaged. Spinal cord injuries were multifocal in about 46.2% of cases. The diagnostic algorithm of instrumental studies in the acute period of spinal injury was performed in the following sequence: spondylograms in two projections (77%), those in special positions (3%), multislice spiral computed tomography (75%), and magnetic resonance imaging (22%)...
May 2012: Vestnik Rentgenologii i Radiologii
Mark Hauswald
The emergency care of patients who may have spinal injuries has become highly ritualised. There is little scientific support for many of the recommended interventions and there is evidence that at least some methods now used in the field and emergency department are harmful. Since prospective clinical trials are not likely to resolve these issues I propose a reconceptualisation of spinal trauma to allow a more rational approach to treatment. To do this I analyse the basic physics, biomechanics and physiology involved...
September 2013: Emergency Medicine Journal: EMJ
Rowan Schouten, Robert Lee, Michael Boyd, Scott Paquette, Marcel Dvorak, Brian K Kwon, Charles Fisher, John Street
The purpose of this ambispective cohort study is to describe the emerging role of intra-operative cone-beam CT (O-arm®, Medtronic, Minneapolis, MN, USA), frequently coupled with stereotactic navigation (StealthStation®, Medtronic), in the surgical management of acute spinal trauma. All patients with acute spinal trauma between May 2009 and May 2011 who were treated with the use of the O-arm were identified from a prospectively collected spine database and retrospectively analyzed to characterize indications and outcomes...
August 2012: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
J C Kelly, D E O'Briain, G A Kelly, J P Mc Cabe
BACKGROUND AND PURPOSE: The provision of appropriate spinal imaging in cases of acute injury as a consequence of trauma or tumour is becoming ever more challenging. This study assessed the use of multimodal radiological investigations in the management of spinal cord compression as a result of trauma and metastatic cancer in all major Irish hospitals. METHODS: We conducted a questionnaire of thirty four hospitals in an effort to assess the provision of these services to patients with possible spinal cord compromise...
April 2012: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
Helen M Ackland, Peter A Cameron, Dinesh K Varma, Gregory J Fitt, D James Cooper, Rory Wolfe, Gregory M Malham, Jeffrey V Rosenfeld, Owen D Williamson, Susan M Liew
STUDY OBJECTIVE: We aim to determine the prevalence and factors associated with cervical discoligamentous injuries detected on magnetic resonance imaging (MRI) in acute, alert, neurologically intact trauma patients with computed tomography (CT) imaging negative for acute injury and persistent midline cervical spine tenderness. We present the cross-sectional analysis of baseline information collected as a component of a prospective observational study. METHODS: Alert, neurologically intact trauma patients presenting to a Level I trauma center with CT negative for acute injury, who underwent MRI for investigation of persistent midline cervical tenderness, were prospectively recruited...
December 2011: Annals of Emergency Medicine
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