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Journal articles on the topic 'Severe spinal cord injury'
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1
Saadoun, Samira, and Marios C. Papadopoulos. "Acute, Severe Traumatic Spinal Cord Injury." Neurosurgery Clinics of North America 32, no. 3 (July 2021): 365–76. http://dx.doi.org/10.1016/j.nec.2021.03.008.
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Ebrahim, Abul Fadl Mohsin. "Severe Spinal Cord Injury: A Case Study." Maghreb Review 34, no. 1 (2009): 61–66. http://dx.doi.org/10.1353/tmr.2009.0023.
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Coen, S. Diane. "Spinal Cord Injury: Preventing Secondary Injury." AACN Advanced Critical Care 3, no. 1 (February 1, 1992): 44–54. http://dx.doi.org/10.4037/15597768-1992-1005.
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Spinal cord injury is devastating to the victim, as well as being costly in terms of medical expenses, lost wages, and lost independence. The initial damage to the spinal cord results from several mechanisms of injury—flexion, extension, compression, penetration, rotation, and the disease process. When the spinal cord is injured and there is necrosis of the nervous tissue, no regeneration of that tissue occurs. Unlike in the peripheral nervous system, where regeneration is possible, the spinal cord is part of the central nervous system, as is the brain. The spinal cord extends from the base of the skull to the L1 vertebrae: the cervical levels innervate the diaphragm and muscles of the arms; the thoracic levels innervate the muscles of the chest and abdomen; and the lumbar and sacral levels innervate the muscles of the legs. In addition, the sacral levels are responsible for bowel, bladder, and sexual function. The higher the level of injury, the more severe the loss of function because, not only is the level of injury affected, but also the levels below. Injury occurs by initial trauma to the surrounding ligaments, bones, and muscles, which then affect the spinal cord. There may be total loss of function with damage completely across the cord or partial loss of function with damage affecting only part of the cord. No current treatment can reverse this initial injury, which causes irreversible damage within minutes of injury. Secondary damage occurs as the injury spreads over several hours. Treatment can help prevent this secondary damage
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Hamilton, Mark G., and S. Terence Myles. "Pediatric spinal injury: review of 61 deaths." Journal of Neurosurgery 77, no. 5 (November 1992): 705–8. http://dx.doi.org/10.3171/jns.1992.77.5.0705.
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✓ Injury to the spinal column and spinal cord occurs relatively infrequently in the pediatric population. The authors present a unique review of 61 pediatric deaths associated with spinal injury. This group represented 28% of the total pediatric spine-injured population and 45% of the total pediatric spinal cord-injured group studied. The ratio of pediatric to adult spinal injury mortality was 2.5:1. Of the 61 children, 54 (89%) died at the accident scene. Thirty patients underwent a complete autopsy, 19 of whom had an Abbreviated Injury Scale Grade 6 injury (maximum score, untreatable). Spinal cord injury was found to be the cause of death in only eight children and was associated with injury to the high cervical cord and cardiorespiratory arrest. These children typically sustained severe multiple trauma. In this population, there appears to be little room for improved outcome through changes in treatment strategy.
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Hogg, FRA, MJ Gallagher, S. Chen, A. Zoumprouli, S. Saadoun, and M. Papadopoulos. "P75 Factors that predict degree of spinal cord compression and optimal spinal cord perfusion pressure in patients with acute, severe traumatic spinal cord injuries." Journal of Neurology, Neurosurgery & Psychiatry 90, no. 3 (February 14, 2019): e41.3-e42. http://dx.doi.org/10.1136/jnnp-2019-abn.134.
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ObjectivesTo identify factors which predict intra-spinal pressure (ISP) and optimal spinal cord perfusion pressure (SCPPopt) in patients with acute, severe traumatic spinal cord injuries (TSCI) that could be used instead of invasive ISP monitoring.MethodsWe monitored ISP, mean arterial pressure (MAP) and computed spinal cord perfusion pressure (SCPP), spinal pressure reactivity index (sPRx) and SCPPopt in 64 TSCI patients, AIS grades A–C who were part of the Injured Spinal Cord Pressure Evaluation (ISCoPE) study. We recorded baseline, injury/imaging and management variables which may influence ISP/SCPPopt. Statistical analysis was used to investigate differences in ISP/SCPPopt between the variablesResults51% (34/64) had U-shaped sPRx vs. SCPP curve in the first 24 hours after surgery. Mean SCPPopt was 74 mmHg (range 48–103). Lower mean 24 hour ISP was found with: older age, alcohol excess, non-conus medullaris injury, duroplasty and less surgical bleeding. Mean ISP on day 1 after surgery correlates with mean ISP over the first week. Lower 24 hour SCPPopt was associated with: higher mean ISP and conus medullaris injury. No MRI factors predicted ISP or SCPPopt.ConclusionsSeveral factors predict ISP. Modifiable factors to reduce ISP are less surgical bleeding and expansion duroplasty. No variables predict SCPPopt. ISP monitoring remains the only way to estimate SCPPopt to help prevent secondary damage and we continue to support use of ISP monitoring to individualise management in acute, severe TSCI.
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Duerstock, Bradley S., and Richard B. Borgens. "Three-dimensional morphometry of spinal cord injury following polyethylene glycol treatment." Journal of Experimental Biology 205, no. 1 (January 1, 2002): 13–24. http://dx.doi.org/10.1242/jeb.205.1.13.
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SUMMARY We are developing a novel means of restoring function after severe acute spinal cord injury. This involves a brief application of polyethylene glycol (PEG) to the site of injury. In the companion paper, we have shown that a delayed application of PEG can produce strikingly significant physiological and behavioral recovery in 90–100 % of spinal-cord-injured guinea pigs. In the present paper, we used three-dimensional computer reconstructions of PEG-treated and sham-treated spinal cords to determine whether the pathological character of a 1-month-old injury is ameliorated by application of PEG. Using a novel isocontouring algorithm, we show that immediate PEG treatment and treatment delayed by up to 7 h post-injury statistically increased the volume of intact spinal parenchyma and reduced the amount of cystic cavitation. Furthermore, in PEG-treated animals, the lesion was more focal and less diffuse throughout the damaged segment of the spinal cord, so that control cords showed a significantly extended lesion surface area. This three-dimensional computer evaluation showed that the functional recovery produced by topical application of a hydrophilic polymer is accompanied by a reduction in spinal cord damage.
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Hoskote, Aparna. "Severe traumatic brain injury and spinal cord injury in children." Hospital Medicine 65, no. 8 (August 2004): 489–92. http://dx.doi.org/10.12968/hosp.2004.65.8.15496.
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Sica, Domenic A., and R. Michael Culpepper. "Case Report: Severe Hyponatremia in Spinal Cord Injury." American Journal of the Medical Sciences 298, no. 5 (November 1989): 331–33. http://dx.doi.org/10.1097/00000441-198911000-00011.
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OKADA, Keiichi, Kimio ONODA, Yasuhiro KAWASHIMA, and Atsushi MUTO. "PULMONARY FUNCTION OF SEVERE CERVICAL SPINAL CORD INJURY." KITAKANTO Medical Journal 37, no. 2 (1987): 219–24. http://dx.doi.org/10.2974/kmj1951.37.219.
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Dietrich, W. Dalton. "Therapeutic hypothermia for acute severe spinal cord injury." Critical Care Medicine 40, no. 2 (February 2012): 691–92. http://dx.doi.org/10.1097/ccm.0b013e318236eacb.
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Morimoto, Tetsuya. "Pathophysiology and Treatment of Severe Spinal Cord Injury." Japanese Journal of Neurosurgery 6, no. 12 (1997): 819–26. http://dx.doi.org/10.7887/jcns.6.819.
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Na, Bo-Ram, and Hyoung-Yeon Seo. "Adult Spinal Cord Injury without Major Bone Injury: Effects of Surgical Decompression and Predictors of Neurological Outcomes in American Spinal Injury Association Impairment Scale A, B, or C." Journal of Clinical Medicine 10, no. 5 (March 6, 2021): 1106. http://dx.doi.org/10.3390/jcm10051106.
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The cervical spine can be injured even in the absence of radiographic abnormality, and the best surgical treatment for adult spinal cord injury without bone injury is debated. The aim of this study was to retrospectively investigate the effect of surgical decompression for severe adult spinal cord injury without major bone injury and to establish predictors of good neurological outcome. We analyzed 11 patients who underwent surgical decompression in severe adult spinal cord injury without major bone injury patients classified as American Spinal Injury Association Impairment Scale (AIS) grade A, B, or C. Neurological assessments were performed using AIS at preoperative and postoperative 1-year follow-up. Radiological evaluations were performed using cervical magnetic resonance imaging (MRI) at preoperative. Seven cases were classified as AIS grade A; two cases as AIS grade B; and two cases as AIS grade C. Five of 11 (45.5%) patients showed improved neurological grade 1-year postoperatively. Intramedullary lesion length (IMLL) (p = 0.047) and compression rate (p = 0.045) had the most powerful effect on AIS grade conversion. This study shows that the fate of the injured spinal cord is determined at the time of the injury, but adequate decompression may have limited contribution to the recovery of neurological function. Compression rate and IMLL on MRI can be used as a predictor of neurological recovery.
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Saadoun, Samira, and Marios C. Papadopoulos. "Targeted Perfusion Therapy in Spinal Cord Trauma." Neurotherapeutics 17, no. 2 (January 8, 2020): 511–21. http://dx.doi.org/10.1007/s13311-019-00820-6.
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AbstractWe review state-of-the-art monitoring techniques for acute, severe traumatic spinal cord injury (TSCI) to facilitate targeted perfusion of the injured cord rather than applying universal mean arterial pressure targets. Key concepts are discussed such as intraspinal pressure and spinal cord perfusion pressure (SCPP) at the injury site, respectively, analogous to intracranial pressure and cerebral perfusion pressure for traumatic brain injury. The concept of spinal cord autoregulation is introduced and quantified using spinal pressure reactivity index (sPRx), which is analogous to pressure reactivity index for traumatic brain injury. The U-shaped relationship between sPRx and SCPP defines the optimum SCPP as the SCPP that minimizes sPRx (i.e., maximizes autoregulation), and suggests that not only ischemia but also hyperemia at the injury site may be detrimental. The observation that optimum SCPP varies between patients and temporally in each patient supports individualized management. We discuss multimodality monitoring, which revealed strong correlations between SCPP and injury site metabolism (tissue glucose, lactate, pyruvate, glutamate, glycerol), monitored by surface microdialysis. Evidence is presented that the dura is a major, but unappreciated, cause of spinal cord compression after TSCI; we thus propose expansion duroplasty as a novel treatment. Monitoring spinal cord blood flow at the injury site has revealed novel phenomena, e.g., 3 distinct blood flow patterns, local steal, and diastolic ischemia. We conclude that monitoring from the injured spinal cord in the intensive care unit is a safe technique that appears to enable optimized and individualized spinal cord perfusion.
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McDonald, John W., Daniel Becker, Cristina L. Sadowsky, John A. Jane, Thomas E. Conturo, and Linda M. Schultz. "Late recovery following spinal cord injury." Journal of Neurosurgery: Spine 97, no. 2 (September 2002): 252–65. http://dx.doi.org/10.3171/spi.2002.97.2.0252.
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✓ The authors of this prospective, single-case study evaluated the potential for functional recovery from chronic spinal cord injury (SCI). The patient was motor complete with minimal and transient sensory perception in the left hemibody. His condition was classified as C-2 American Spinal Injury Association (ASIA) Grade A and he had experienced no substantial recovery in the first 5 years after traumatic SCI. Clinical experience and evidence from the scientific literature suggest that further recovery would not take place. When the study began in 1999, the patient was tetraplegic and unable to breathe without assisted ventilation; his condition classification persisted as C-2 ASIA Grade A. Magnetic resonance imaging revealed severe injury at the C-2 level that had left a central fluid-filled cyst surrounded by a narrow donutlike rim of white matter. Five years after the injury a program known as “activity-based recovery” was instituted. The hypothesis was that patterned neural activity might stimulate the central nervous system to become more functional, as it does during development. Over a 3-year period (5–8 years after injury), the patient's condition improved from ASIA Grade A to ASIA Grade C, an improvement of two ASIA grades. Motor scores improved from 0/100 to 20/100, and sensory scores rose from 5–7/112 to 58–77/112. Using electromyography, the authors documented voluntary control over important muscle groups, including the right hemidiaphragm (C3–5), extensor carpi radialis (C-6), and vastus medialis (L2–4). Reversal of osteoporosis and an increase in muscle mass was associated with this recovery. Moreover, spasticity decreased, the incidence of medical complications fell dramatically, and the incidence of infections and use of antibiotic medications was reduced by over 90%. These improvements occurred despite the fact that less than 25 mm2 of tissue (approximately 25%) of the outer cord (presumably white matter) had survived at the injury level. The primary novelty of this report is the demonstration that substantial recovery of function (two ASIA grades) is possible in a patient with severe C-2 ASIA Grade A injury, long after the initial SCI. Less severely injured (lower injury level, clinically incomplete lesions) individuals might achieve even more meaningful recovery. The role of patterned neural activity in regeneration and recovery of function after SCI therefore appears a fruitful area for future investigation.
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Lewis, Kelly S., and Wade M. Mueller. "Intrathecal Baclofen for Severe Spasticity Secondary to Spinal Cord Injury." Annals of Pharmacotherapy 27, no. 6 (June 1993): 767–74. http://dx.doi.org/10.1177/106002809302700618.
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OBJECTIVE: To evaluate the use of intrathecal baclofen for the treatment of muscle spasticity in patients with spinal cord injury. DATA SOURCES: A MEDLINE search was used to identify relevant and pertinent literature. Information was obtained from open-label clinical trials, abstracts, conference proceedings, and review articles. Index terms in the search included baclofen, spasticity, intrathecal drug infusion, spinal cord disease, and neurosurgery. DATA EXTRACTION: Studies were selected for review if they evaluated intrathecal baclofen in patients with spinal cord injury. Emphasis was placed on human studies published in the English language. Trials were reviewed by dosage regimen, therapeutic response, adverse effects, and complications. DATA SYNTHESIS: Thus far, intrathecal baclofen administration shows promise in the treatment of spasticity resulting from spinal cord trauma. Few complications and adverse effects have been reported. CONCLUSIONS: Muscle spasms and spasticity constitute a significant problem in spinal cord injuries, interfering with rehabilitation and leading to inconveniences and complications in these patients. Oral baclofen is the drug of choice for spasticity due to spinal cord trauma. It often is ineffective, however, because of the large dosages required to cross the blood-brain barrier and the subsequent appearance of central nervous system adverse effects. These adverse effects are not tolerated by many patients. Intrathecally administered baclofen has been approved by the Food and Drug Administration (FDA) for the treatment of spasticity in patients with spinal cord injury who are refractory to or cannot tolerate oral baclofen. It is intended for use only in implantable pumps approved by the FDA for the administration of baclofen into the intrathecal space. Intrathecal administration achieves high concentrations in the spinal cord with small dosages, thus reducing the incidence of central nervous system adverse effects. To date, approximately 350 patients with spinal cord injury have been treated with intrathecal baclofen. Reductions in spasticity have been demonstrated in both open-label and placebo-controlled trials. Patients also often make substantial gains in activities of daily living. Few adverse effects and complications have been reported. However, tolerance to the clinical effects of intrathecal baclofen has been reported. Further studies are needed to determine specific patient populations that may benefit most from intrathecal baclofen administration. Individual dosage ranges and follow-up care also need to be defined more completely. In addition, the question of whether tolerance detracts from long-term clinical benefits with intrathecal baclofen needs to be addressed.
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McClellan, Andrew D. "Spinal Cord Injury: Lessons from Locomotor Recovery and Axonal Regeneration in Lower Vertebrates." Neuroscientist 4, no. 4 (July 1998): 250–63. http://dx.doi.org/10.1177/107385849800400414.
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After severe spinal cord injury in adult higher vertebrates (birds and mammals), there normally is little or no axonal regeneration and virtually no recovery of voluntary locomotor function below the lesion. In contrast, certain lower vertebrates, including lamprey, fish, and some amphibians, exhibit robust axonal regeneration and substantial recovery of locomotor function after spinal cord injury. The remarkable behavioral recovery of lower vertebrates with spinal cord injuries is due to at least three factors: 1) minimal hemorrhagic necrosis at the injury site and the lack of a neurite growth–inhibiting astrocytic scar, 2) an environment in the spinal cord that is permissive for axonal regeneration, and 3) mechanisms for directed axonal elongation and selection of appropriate postsynaptic targets. The latter two features probably represent developmental mechanisms for axonal guidance and synaptogenesis that persist in the nervous systems of these animals well beyond the main phase of neural development. In the injured spinal cords of higher vertebrates, the full complement of manipulations necessary to promote functional regeneration and behavioral recovery is unknown. An understanding of the mechanisms that result in repair of spinal cord injuries in lower vertebrates may provide guidelines for identifying the requirements for functional spinal cord regeneration in higher vertebrates, including humans.
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Ribeiro, Ana, Joana F. Monteiro, Ana C. Certal, Ana M. Cristovão, and Leonor Saúde. "Foxj1a is expressed in ependymal precursors, controls central canal position and is activated in new ependymal cells during regeneration in zebrafish." Open Biology 7, no. 11 (November 2017): 170139. http://dx.doi.org/10.1098/rsob.170139.
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Zebrafish are able to regenerate the spinal cord and recover motor and sensory functions upon severe injury, through the activation of cells located at the ependymal canal. Here, we show that cells surrounding the ependymal canal in the adult zebrafish spinal cord express Foxj1a. We demonstrate that ependymal cells express Foxj1a from their birth in the embryonic neural tube and that Foxj1a activity is required for the final positioning of the ependymal canal. We also show that in response to spinal cord injury, Foxj1a ependymal cells actively proliferate and contribute to the restoration of the spinal cord structure. Finally, this study reveals that Foxj1a expression in the injured spinal cord is regulated by regulatory elements activated during regeneration. These data establish Foxj1a as a pan-ependymal marker in development, homeostasis and regeneration and may help identify the signals that enable this progenitor population to replace lost cells after spinal cord injury.
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Hamilton, Mark G., and S. Terence Mylks. "Pediatric spinal injury: review of 174 hospital admissions." Journal of Neurosurgery 77, no. 5 (November 1992): 700–704. http://dx.doi.org/10.3171/jns.1992.77.5.0700.
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✓ Injury to the spinal column and spinal cord occurs relatively infrequently in the pediatric population. A review of 174 pediatric patients is presented, representing 5.4% of all patients admitted with spinal injury, Spinal cord injury was present in 45% of patients. A distinct injury profile, explained by anatomical and biomechanical features, distinguishes the young patient with an immature spine from older adolescents with a more mature, adult-like spine. The younger patients, while less likely to have spinal injury, had a higher incidence of neurological injury, in addition to a higher frequency of both spinal cord injury without radiological abnormality and upper cervical cord injury. In addition, younger patients with spinal cord injury and no radiological abnormality were more likely to have complete or severe cord injury. Prognosis was determined by the severity of spinal cord injury. Patients with complete cord injuries showed little improvement, while patients with incomplete injuries generally fared much better, with 74% showing significant improvement and 59% experiencing a complete recovery of neurological functions. There were six deaths, but none was attributed solely to spinal injury. The authors conclude that outcome is quite good after pediatric spinal cord injury that does not produce a physiologically complete cord deficit.
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Tator, Charles H., and Izumi Koyanagi. "Vascular mechanisms in the pathophysiology of human spinal cord injury." Neurosurgical Focus 2, no. 1 (January 1997): E2. http://dx.doi.org/10.3171/foc.1997.2.1.2.
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Vascular injury plays an important role in the primary and secondary injury mechanisms that cause damage to the acutely traumatized spinal cord. To understand the pathophysiology of human spinal cord injury, the authors investigated the vascular system in three uninjured human spinal cords using silicone rubber microangiography and analyzed the histological findings related to vascular injury in nine acutely traumatized human spinal cords obtained at autopsy. The interval from spinal cord injury to death ranged from 20 minutes to 9 months. The microangiograms of the uninjured human cervical cords demonstrated new information about the sulcal arterial system and the pial arteries. The centrifugal sulcal arterial system was found to supply all of the anterior gray matter, the anterior half of the posterior gray matter, approximately the inner half of the anterior and lateral white columns, and the anterior half of the posterior white columns. Traumatized spinal cord specimens in the acute stage (3-5 days postinjury) showed severe hemorrhages predominantly in the gray matter, but also in the white matter. The white matter surrounding the hemorrhagic gray matter showed a variety of lesions, including decreased staining, disrupted myelin, and axonal and periaxonal swelling. The white matter lesions extended far from the injury site, especially in the posterior columns. There was no evidence of complete occlusion of any of the larger arteries, including the anterior and posterior spinal arteries and the sulcal arteries. However, occluded intramedullary veins were identified in the degenerated posterior white columns. In the chronic stage (3-9 months postinjury), the injured segments showed major tissue loss with large cavitations, whereas both rostral and caudal remote sites showed well-demarcated necrotic areas indicative of infarction mainly in the posterior white columns. Obstruction of small intramedullary arteries and veins by the initial mechanical stress or secondary injury mechanisms most likely produced these extensive white matter lesions. Our studies implicate damage to the anterior sulcal arteries in causing the hemorrhagic necrosis and subsequent central myelomalacia at the injury site in acute spinal cord injury in humans.
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Tator, Charles H., and Izumi Koyanagi. "Vascular mechanisms in the pathophysiology of human spinal cord injury." Journal of Neurosurgery 86, no. 3 (March 1997): 483–92. http://dx.doi.org/10.3171/jns.1997.86.3.0483.
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✓ Vascular injury plays an important role in the primary and secondary injury mechanisms that cause damage to the acutely traumatized spinal cord. To understand the pathophysiology of human spinal cord injury, the authors investigated the vascular system in three uninjured human spinal cords using silicone rubber microangiography and analyzed the histological findings related to vascular injury in nine acutely traumatized human spinal cords obtained at autopsy. The interval from spinal cord injury to death ranged from 20 minutes to 9 months. The microangiograms of the uninjured human cervical cords demonstrated new information about the sulcal arterial system and the pial arteries. The centrifugal sulcal arterial system was found to supply all of the anterior gray matter, the anterior half of the posterior gray matter, approximately the inner half of the anterior and lateral white columns, and the anterior half of the posterior white columns. Traumatized spinal cord specimens in the acute stage (3–5 days postinjury) showed severe hemorrhages predominantly in the gray matter, but also in the white matter. The white matter surrounding the hemorrhagic gray matter showed a variety of lesions, including decreased staining, disrupted myelin, and axonal and periaxonal swelling. The white matter lesions extended far from the injury site, especially in the posterior columns. There was no evidence of complete occlusion of any of the larger arteries, including the anterior and posterior spinal arteries and the sulcal arteries. However, occluded intramedullary veins were identified in the degenerated posterior white columns. In the chronic stage (3–9 months postinjury), the injured segments showed major tissue loss with large cavitations, whereas both rostral and caudal remote sites showed well-demarcated necrotic areas indicative of infarction mainly in the posterior white columns. Obstruction of small intramedullary arteries and veins by the initial mechanical stress or secondary injury mechanisms most likely produced these extensive white matter lesions. Our studies implicate damage to the anterior sulcal arteries in causing the hemorrhagic necrosis and subsequent central myelomalacia at the injury site in acute spinal cord injury in humans.
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Li, Jianping, Zhisheng Ji, Yu Wang, Tiantian Li, Jinghua Luo, Jun Li, Xueshuang Shi, Liming Li, Liumin He, and Wutian Wu. "Human Adipose-Derived Stem Cells Combined with Nano-Hydrogel Promote Functional Recovery after Spinal Cord Injury in Rats." Biology 11, no. 5 (May 20, 2022): 781. http://dx.doi.org/10.3390/biology11050781.
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The treatment of spinal cord injury aims to reconstruct the fiber connection and restore the interrupted neural pathways. Adipose mesenchymal stem cells (ADSCs) can promote the recovery of motor functions in spinal cord injury. However, poor survival of ADSCs and leakage outside of the injury site after local transplantation reduce the number of cells, which seriously attenuates the cumulative effect. We performed heterotopic transplantation on rats with severe spinal cord injury using human ADSCs loaded within self-assembly hydrogel RADA16-RGD (R: arginine; A: alanine; D: aspartic acid; G: glycine). Our results indicate that the combined transplantation of human ADSCs with RADA16-RGD improved the survival of ADSCs at the injured site. The inflammatory reaction was inhibited, with improved survival of the neurons and increased residual area of nerve fibers and myelin protein. The functional behaviors were promoted, as determined by the Basso, Beattie, and Bresnahan (BBB) locomotor rating scale score and electrophysiological measurements. ADSCs can promote the repair of spinal cord injury. This study provides new ideas for the treatment of spinal cord injury.
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Ramalho, Fernando S., Aparecida Y. Yamamoto, Luis L. da Silva, Luiz T. M. Figueiredo, Lenaldo B. Rocha, Luciano Neder, Sara R. Teixeira, et al. "Congenital Zika Virus Infection Induces Severe Spinal Cord Injury." Clinical Infectious Diseases 65, no. 4 (April 21, 2017): 687–90. http://dx.doi.org/10.1093/cid/cix374.
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Hong, James, Alex Chang, Yang Liu, Jian Wang, and Michael G. Fehlings. "Incomplete Spinal Cord Injury Reverses the Level-Dependence of Spinal Cord Injury Immune Deficiency Syndrome." International Journal of Molecular Sciences 20, no. 15 (August 1, 2019): 3762. http://dx.doi.org/10.3390/ijms20153762.
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Spinal cord injury (SCI) is associated with an increased susceptibility to infections, such as pneumonia, which is the leading cause of death in these patients. This phenomenon is referred to as SCI immune deficiency syndrome (SCI-IDS), and has been shown to be more prevalent after high-level transection in preclinical SCI models. Despite the high prevalence of contusion SCIs, the effects of this etiology have not been studied in the context of SCI-IDS. Compared to transection SCIs, which involve a complete loss of supraspinal input and lead to the disinhibition of spinally-generated activity, contusion SCIs may cause significant local deafferentation, but only a partial disruption of sympathetic tone below the level of injury. In this work, we investigate the effects of thoracic (T6-7) and cervical (C6-7) moderate–severe contusion SCIs on the spleen by characterizing splenic norepinephrine (NE) and cortisol (CORT), caspase-3, and multiple inflammation markers at 3- and 7-days post-SCI. In contrary to the literature, we observe an increase in splenic NE and CORT that correspond to an increase in caspase-3 after thoracic SCI relative to cervical SCI. Further, we found differences in expression of leptin, eotaxin, IP-10, and IL-18 that implicate alterations in splenocyte recruitment and function. These results suggest that incomplete SCI drastically alters the level-dependence of SCI-IDS.
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Ramamurthy, Poornashree, Naveen Kumar, and Aheed Osman. "Epidemiology, neurological and functional outcome of concomitant traumatic brain and spinal cord injury: An Oswestry experience." Trauma 19, no. 1_suppl (July 18, 2017): 30–32. http://dx.doi.org/10.1177/1460408617718868.
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Background Concomitant traumatic brain injury with spinal cord injury is likely to worsen prognosis and increase hospital length of stay. This study assessed the duration of in-patient rehabilitation and outcome in patients with both traumatic brain injury and spinal cord injury. Methods Retrospective study of all patients with concomitant traumatic brain injury and spinal cord injury over a 3-year period who had 5 years of subsequent follow-up at the Midlands Centre for Spinal Injuries. Results Twenty-seven patients had concomitant injuries of which five had severe traumatic brain injury, nine had moderate traumatic brain injury and the remaining thirteen had mild traumatic brain injury with spinal cord injury of grades A–D; commonest mechanisms of injury were motor vehicle collision (55%) and falls (37%). Thirteen (48%) had tetraplegia and 14 (52%) had paraplegia. Mean functional independence measure score at admission was 52.1 and 103.4 at 5 years. Patients with mild traumatic brain injury gained a mean functional independence measure score of 67.1; the moderate and severe traumatic brain injury patients gained mean functional independence measure score of 60.1 and 69.2, respectively. The mean length of stay was 138.3, 139.4 and 153.4 days for mild, moderate and severe traumatic brain injury, respectively. Conclusion Hospital length of stay and patient’s functioning at 5 years were not affected by traumatic brain injury severity in this subgroup; however, functional independence measure on its own may not be very sensitive to cognitive deficits.
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Fatimah Ahmedy, Khin Nyein Yin, and Sadia Choudury Shimmi. "Spinal Cord Injury Rehabilitation: Basics and Beyond." Borneo Journal of Medical Sciences (BJMS) 16 (March 22, 2022): 1–2. http://dx.doi.org/10.51200/bjms.v16i.3708.
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This special issue is dedicated to the Borneo International Spinal Cord Injury (SCI) Rehabilitation Conference (BISCIR) which was held on 30th July – 1st August 2021 through a virtual platform. It was co-organized by the Department of Rehabilitation Medicine, Queen Elizabeth Hospital, and Rehabilitation Medicine Unit, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah in partnership with Docquity and Kelab Perubatan Rehabilitasi Sabah. Attended by almost 500 delegates from Southeast Asian countries including the hosting country of Malaysia, the conference served its purpose as a global sharing platform by having invited local and international experts from Thailand, the Philippines, India, South Korea, and Australia. With the theme “SCI Rehabilitation: Basics and Beyond”, there was a great opportunity for participating delegates to submit their abstracts for oral and poster competition on spinal cord-related disorders and their rehabilitation. The covered areas include but are not exhaustive to the spinal cord pathophysiology, disease presentations, complications, and management, as well as rehabilitation interventions. Each submitted abstract was double-blinded peer-reviewed by two external reviewers. A total of 15 abstracts were accepted after rigorous review based on objective judging criteria, with seven and eight abstracts as oral and poster submissions respectively. Most of them were case reports with four cross-sectional studies and one review article. “Managing Tetraplegia with Blindness: Rehabilitation Approach” presented the improvement in mobility and daily living skills through orientation and mobility training with sensory education and repeated verbal instructions for compensating the loss of visual and sensory feedback. The “International Lower Urinary Tract Function Data Set: A Study in SCI Population in HRC” reviews the epidemiology of spinal cord injury patients with the neurogenic bladder in the largest rehabilitation hospital in Malaysia. “Navigating Neurological Recovery with NeuroAiD in Severe Spinal Cord Injury: A Noteworthy Novelty?” reported a case of complete tetraplegia who regained some neurological recovery following NeuroAiD supplementation. “A Case of Incomplete Spinal Cord Injury Associated with Brown Sequard Syndrome After Cervical Blunt Trauma with Atlanto-Axial Rotatory Subluxation in a Paediatric Patient” exhibited a case of a paediatric patient with high cervical spinal cord injury secondary to blunt trauma that has resulted in atlantoaxial rotatory subluxation. The “Long Cervicothoracolumbal Rigid Bracing Stabilization on Incomplete Spinal Cord Injury of Post-Operated Multi-Focal Upper Cervical-Thoracic Spinal Tuberculosis: A Unique Case Report” showed that the use of long CTLSO rigid external stabilization justifies the reason to boost protection while recovering from spinal tuberculosis despite receiving stable internal stabilization. “Orthotic Intervention for Ageing Individuals with Spinal Cord Injury: A Brief Review” explored the use of orthotic intervention among the elderly with SCI in 25 published articles. The “Demographic Characteristic of Spinal Cord Injury Patients Referred for Rehabilitation in Miri Hospital” aimed to explore the demographic characteristics among the referrals for rehabilitation among spinal cord injury populations in that tertiary hospital. The “Autonomic Dysreflexia with Concurrent Orthostatic Hypotension: A Clinical Approach Dilemma” highlighted the complicated conditions of managing concurrent Autonomic dysreflexia and orthostatic hypotension in a patient with high cervical spinal cord injury. “A Pinch of Salt Won’t Kill: The Role of Salt Tablets in Reversing Intractable Orthostatic Hypotension in an Incomplete Tetraplegic Patient” presented a case of intractable orthostatic hypotension in incomplete tetraplegia, which resolved after the initiation of salt tablets. The “Marching Forward with Mirabegron: A Novel Treatment Option for Neurogenic Detrusor Overactivity in Traumatic Spinal Cord Injury” showcased a case of young traumatic paraplegia who has been successfully treated with Mirabegron as an alternative to anticholinergics in treating overactive bladder for its better tolerability and comparable efficacy. “A Retrospective Pilot Study on the Prevalence of Acceptability for Teleconsultation among Spinal Cord Injury Patients” observed the acceptability of teleconsultation among SCI patients in a major tertiary rehabilitation hospital with a description of their clinical and demographic features. “Performing Solat in Spinal Cord Injury Patients: Challenges and Solutions” emphasized the importance to educate healthcare workers for identifying the limitations and leniency in Islam related to performing prayer (solah) and understand the conditions of the validity of the performed prayer as means to equip patients with the right knowledge and method. The ”Sharing of Experience of Teleconsultation with Spinal Cord Injury Patients” proven that the use of teleconsultation is a beneficial service among SCI patients during the COVID-19 pandemic. “Fleet Enema-Induced Autonomic Dysreflexia in Spinal Cord Injured Patient” reported the use of fleet enema in spinal cord injured patients that can cause autonomic response leading to severe complication of a generalized tonic-clonic seizure. The “An Uncommon Case Post-traumatic Syringobulbia: A Case Report” showed that the formation of syringobulbia, although rare, is one of the causes of the delayed-onset neurological deterioration in spinal cord injured patients. The accepted abstracts are presented in the following sections of this issue. Readers are welcome to contact us for any comments or queries.
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Safronov, D. L., A. A. Kolyabin, A. A. Grischuk, A. K. Poverinov, M. A. Shongina, A. V. Mazaeva, and V. R. Ramazanov. "Orthotic experience in spinal cord injury (case report)." Genij Ortopedii 28, no. 3 (June 2022): 425–30. http://dx.doi.org/10.18019/1028-4427-2022-28-3-425-430.
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Relevance Traumatic spinal cord injury is a complex, urgent and multidisciplinary problem with a high percentage of disability and subsequent social exclusion. Treatment of neuroorthopedic pathologies is often associated with the need to use technical means of rehabilitation. The objective was to develop a successful orthosis for a patient with severe spinal cord injury. Material and methods The article describes a clinical case of a 16-year-old female patient with the outcome of a severe concomitant injury: lower paraplegia, sensory disturbances in the lower extremities and pelvic organ function. MRI of the spinal cord revealed cystic-glial changes and atrophy of the spinal cord at the Th10-12 level. Results and discussion With clinical signs of paraplegia and a complete spinal cord injury according to the instrumentation findings, the patient had poor prognosis for the recovery of motor functions in the lower limbs. One of the main tasks of medical rehabilitation of patients with spinal cord injury is the activation of movements and restoration of locomotion. The Hip-Knee-Ankle-Foot Orthosis (HKAFO) manufactured at the Center was intended for unloading, replacement and fixation. The device was light and strong due to greater use of carbon layers, equipped with functional hinges to prevent development of contractures, had a high corset for external stabilization of the body and double knee splint for safe standing. Conclusion For the paraplegic patient, the opportunity to stand and walk with the support using successful orthosis was important from both physical and psychosocial perspectives and allowed correction of contractures in the catamnesis.
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Li, Xing, and Jianwu Dai. "Bridging the gap with functional collagen scaffolds: tuning endogenous neural stem cells for severe spinal cord injury repair." Biomaterials Science 6, no. 2 (2018): 265–71. http://dx.doi.org/10.1039/c7bm00974g.
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Broome, J. R. "Aspects of neurological decompression illness: A view from Bethesda." Journal of The Royal Naval Medical Service 81, no. 2 (1995): 120–26. http://dx.doi.org/10.1136/jrnms-81-120.
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AbstractA minority of divers with neurological decompression illness (DCI) fail to improve with recompression treatment. This is particularly seen in cases where features of severe spinal cord injury develop soon after surfacing. Haemorrhage into the spinal cord is implicated in the pathogenesis of these cases, and evidence is presented that supports the view that the bleeding coincides with shrinkage of autochthonous bubbles. The role of hyperbaric oxygen therapy in the treatment of spinal cord DCI is discussed with reference to posssible benefit in ischaemia-reperfusion (I-R) injury. Similarities and differences between the tissue injury of dysbaric and conventional spinal cord injury are outlined. The implications of advances in drug therapy for conventional spinal cord trauma are considered in the context of their potential application to treat neurological DCI.
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Greene, William B. "In situ cryofixation of rat spinal cord by a new propane jet freezing device." Proceedings, annual meeting, Electron Microscopy Society of America 51 (August 1, 1993): 102–3. http://dx.doi.org/10.1017/s0424820100146357.
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Spinal cord trauma is a major health problem in terms of morbidity and mortality. It is clear that traumatic spinal cord injury is related to the death of a cord segment which results in the structural and functional disruption of key pathways vital to the maintenance of normal neurological function. The injured area of the cord eventually becomes a zone of segmental necrosis which, in the more severe cases, involves all but a thin rim of sub-pial white matter. The clinical consequences of segmental necrosis can be consistently reproduced in experimental animals by dropping weights onto the surgically exposed cord. At the moment of impact and during the primary injury phase, there are changes in the spinal cord which indicate that neural membranes are altered. The extent and reversibility of these alterations are being investigated for therapeutic treatment. Emphasis has been placed principally on secondary events leading to calcium toxicity. An ultra-rapid freezing technique evolved from the necessity of preserving diffusible ions in situ before and after spinal cord injury.
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Thelakkadan, Abidfaheem, and Leena Kunnath Chacko. "Caregiver Burden of Primary Caregivers for People with Spinal Cord Injury (SCI) Residing at Calicut District Kerala." Journal of Evolution of Medical and Dental Sciences 10, no. 8 (February 22, 2021): 458–62. http://dx.doi.org/10.14260/jemds/2021/101.
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BACKGROUND The study aims to assess the caregiver burden of primary caregivers of people with spinal cord injury by using Caregiver Burden Scale (CBS), find the association between caregiver burden and selected socio-demographic variables and find the association between caregiver burden and characteristics of individuals with spinal cord injury. METHODS A cross sectional study was conducted from June 2019 to December 2019 among primary caregivers of patients with spinal cord injury (SCI) residing in selected communities of Calicut district, Kerala state, India. Purposive sampling technique was used to select samples. Caregiver burden was assessed by Zarit Caregiver Burden Interview. Characteristics of caregivers and individuals with spinal cord injury were collected by structured interview. RESULTS Study was conducted among 100 primary caregivers of individuals with spinal cord injury. The mean score of caregiver burden is 45.3 with SD 11.4. Out of the total sample, 40 % of the caregivers suffered from mild to moderate burden, another 40 % suffered from moderate to severe burden and the remaining 20 % of them suffered from severe caregiver burden. The study also found an association between caregiver burden score with characteristics of caregivers such as age (p = 0.038), gender (p = 0.02) and marital status (p = 0.048). Study also found an association between the gender of patient (p = 0.001) and level of injury (p = 0.001). CONCLUSIONS Majority of the sample showed moderate to severe level of caregiver burden. The study helped to find out multiple factors affecting caregiver burden. Health care system can identify these factors and consider them while planning and implementing different programs for individuals with SCI. Measures can be considered to alleviate caregiver burden by considering the findings of the current study and the community can plan different rehabilitative services which can reduce the burden of caregivers. KEY WORDS Caregiver Burden, Spinal Cord Injury, Primary Caregivers
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Grossman, Robert G., Ralph F. Frankowski, Keith D. Burau, Elizabeth G. Toups, John W. Crommett, Michele M. Johnson, Michael G. Fehlings, et al. "Incidence and severity of acute complications after spinal cord injury." Journal of Neurosurgery: Spine 17, Suppl1 (September 2012): 119–28. http://dx.doi.org/10.3171/2012.5.aospine12127.
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Object The aim of this multicenter, prospective study was to determine the spectrum, incidence, and severity of complications during the initial hospitalization of patients with spinal cord injury. Methods The study was conducted at 9 university-affiliated hospitals that comprise the clinical centers of the North American Clinical Trials Network (NACTN) for Treatment of Spinal Cord Injury. The study population comprised 315 patients admitted to NACTN clinical centers between June 25, 2005, and November 2, 2010, who had American Spinal Injury Association (ASIA) Impairment Scale grades of A–D and were 18 years of age or older. Patients were managed according to a standardized protocol. Results The study population was 79% male with a median age of 44 years. The leading causes of injury were falls (37%) and motor vehicle accidents (28%). The distribution of initial ASIA grades were A (40%), B (16%), C (15%), and D (29%). Fifty-eight percent of patients sustained 1 or more severe, moderate, or mild complications. Complications were associated with more severe ASIA grade: 84% of patients with Grade A and 25% of patients with Grade D had at least 1 complication. Seventy-eight percent of complications occurred within 14 days of injury. The most frequent types of severe and moderate complications were respiratory failure, pneumonia, pleural effusion, anemia, cardiac dysrhythmia, and severe bradycardia. The mortality rate was 3.5% and was associated with increased age and preexisting morbidity. Conclusions Knowledge of the type, frequency, time of occurrence, and severity of specific complications that occur after spinal cord injury can aid in their early detection, treatment, and prevention. The data are of importance in evaluating and selecting therapy for clinical trials.
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Haenzi, Barbara, and Lawrence D. F. Moon. "The Function of FGFR1 Signalling in the Spinal Cord: Therapeutic Approaches Using FGFR1 Ligands after Spinal Cord Injury." Neural Plasticity 2017 (2017): 1–13. http://dx.doi.org/10.1155/2017/2740768.
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Extensive research is ongoing that concentrates on finding therapies to enhance CNS regeneration after spinal cord injury (SCI) and to cure paralysis. This review sheds light on the role of the FGFR pathway in the injured spinal cord and discusses various therapies that use FGFR activating ligands to promote regeneration after SCI. We discuss studies that use peripheral nerve grafts or Schwann cell grafts in combination with FGF1 or FGF2 supplementation. Most of these studies show evidence that these therapies successfully enhance axon regeneration into the graft. Further they provide evidence for partial recovery of sensory function shown by electrophysiology and motor activity evidenced by behavioural data. We also present one study that indicates that combination with additional, synergistic factors might further drive the system towards functional regeneration. In essence, this review summarises the potential of nerve and cell grafts combined with FGF1/2 supplementation to improve outcome even after severe spinal cord injury.
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Kamano, Shuji. "Are steroids really ineffective for severely head injured patients?" Neurosurgical Focus 8, no. 1 (January 2000): 1–5. http://dx.doi.org/10.3171/foc.2000.8.1.1640.
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The “Guidelines for the Management of Severe Head Injury” states that the use of glucocorticoids is not recommended for improving morbidity outcome. Conversely, the “National Acute Spinal Cord Injury Study” (NASCIS) in the United States concluded that treatment with very high doses of methylprednisolone (30 mg/kg) is indicated for acute spinal cord trauma. In this paper the author will discuss the reasons for this great discrepancy between head injuries and spinal cord traumas. A 30-mg dose of methylprednisolone was used as a bolus dose in the spinal cord study to inhibit oxygen free radical-induced lipid peroxidation. In most of the papers cited containing Class I data on severe head injury studies the investigators used smaller doses of glucocorticoids as compared with those in the spinal cord study. Moreover, some of the papers included cases in which the time from insult to the initiation of treatment had been poorly controlled. Therefore, based on previous papers, it is appropriate to relinquish megadose steroid therapy for head injury patients. A good prospective multicenter trial of high-dose methylprednisolone for traumatic brain injury should be considered in which dosage and timing parameters similar to those enacted for the NASCIS studies are used.
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Hofstoetter, Ursula S., and Karen Minassian. "Transcutaneous Spinal Cord Stimulation: Advances in an Emerging Non-Invasive Strategy for Neuromodulation." Journal of Clinical Medicine 11, no. 13 (July 1, 2022): 3836. http://dx.doi.org/10.3390/jcm11133836.
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Recent studies of epidural electrical spinal cord stimulation have shown the enabling and, in some cases, the recovery of motor functions thought to be irreversibly lost due to severe spinal cord injury [...]
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Abed Ali, Diaa K., and Narmeen B. Tawfiq. "Assessment of Spinal Cord Injured Persons, Quality of Life." Kufa Journal for Nursing Sciences 3, no. 1 (February 23, 2013): 2031–243. http://dx.doi.org/10.36321/kjns.vi20131.2416.
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AbstractSpinal cord injuries are a global health problem, which strikes millions of people worldwide, and causing either a lifetime severs disability or death. Objectives To assess spinal cord injured persons quality of life. Methodology A descriptive quantitative study is carried out at Ibn AL-Kuff Hospital for spinal cord injuries, started from December 20th, 2009 to July 20th, 2010. A non-probability (Purposive sample) of (100) spinal cord injured persons, who were clients of Ibn AL-Kuff hospital for spinal cord injuries/ outpatient clinic after at least 6 months after their discharged from the hospital for medical follow-up and rehabilitation, within 16 years old or more. The data are collected through the use of semi-constructed questionnaire, which consists of three parts (1) Socio-demographic data form that consist 9-items (2) clinical characteristics form that consist of 10-items and (3) Main domains of the quality of life, which consist of six main domains: physical, psychological, level of independence, social, environmental, and spiritual domain, by means of direct interview technique with the spinal cord injured persons. Reliability of the questionnaire is determined through a pilot study and the validity through a panel of (15) experts. The data were described statistically and analyzed through use of the descriptive and inferential statistical analysis procedures. Results The findings of the present study indicate that the spinal cord injury affect the quality of life domains. The maximal affect presented by the social domain, followed by the level of independence domain, the psychological domain, then the physical domain. While the minimal effect, presented by spiritual domain, followed by the environmental domain. There is a significant relationship between gender, age, marital status after injury, level of education, occupational status after the injury, levels of injury, types of injury, duration of injury, associated diseases, follow-up and physiotherapist visits, use of assistive aids, and the possible complications after injury and quality of life domains. There is a non-significant relationship between residence, marital status before injury, occupational status before injury, socio-economic status, and causes of injury and quality of life domains.Conclusion The study concludes that the spinal cord injury most common occurs among persons in urban residential area than in those in rural. Spinal cord injury most occurs in male than in females. Spinal cord injury does not affect the continuity of the person's marital relationships. Also the study confirmed that the spinal cord injury affects negatively on the continuity of the persons jobs. In addition, the study indicates that the external trauma is the most common cause of the spinal cord injury. Moreover, paraplegic injury is the most common level in spinal cord injuries than tetraplegics injury. Also the incomplete injury is the most common type of spinal cord injuries. And, the spinal cord injury associated with many complications involves all the body systems.  Recommendations The study recommends that an intensive comprehensive wide population-based studies be conducted to assess the spinal cord injured persons, quality of life. Also, an intensive comprehensive wide population-based education programs be conducted to support the nurses' knowledge and practice toward spinal cord injury management and rehabilitation. And health oriented mass media approach should be employed by the Ministry of Health to increase population knowledge and awareness of spinal cord injury. Health oriented mass media approach should be employed by the Ministry of Health to increase population knowledge and awareness of spinal cord injury.Key wards: assessment, spinal cord injuries, quality of life
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Martínez-Lage, Juan F., Fernando Alarcón, Raul Alfaro, Amparo Gilabert, Susana B. Reyes, María-José Almagro, and Antonio López López-Guerrero. "Severe spinal cord injury in craniocervical dislocation. Case-based update." Child's Nervous System 29, no. 2 (September 8, 2012): 187–94. http://dx.doi.org/10.1007/s00381-012-1915-5.
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Kanezaki, Shozo, Keisuke Ishii, Masashi Miyazaki, Sanshi Tanabe, Keiko Kurosawa, and Hiroshi Tsumura. "Severe hypothermia secondary to spinal cord injury without radiographic abnormality." Acute Medicine & Surgery 2, no. 2 (October 20, 2014): 117–19. http://dx.doi.org/10.1002/ams2.73.
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Shields, Richard K., and Shauna Dudley-Javoroski. "Musculoskeletal Deterioration and Hemicorporectomy After Spinal Cord Injury." Physical Therapy 83, no. 3 (March 1, 2003): 263–75. http://dx.doi.org/10.1093/ptj/83.3.263.
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Abstract Background and Purpose. The long-term management following an hemicorporectomy (HCP) is not well documented in the scientific literature. The purpose of this case report is to describe the 25-year history of a man with a spinal cord injury who experienced severe musculoskeletal deterioration and hemicorporectomy. Case Description. The client sustained T10 complete paraplegia at age 18 years, developed severe decubitus ulcers, and required an HCP as a life-saving measure 13 years later. The authors describe the chronology of several rehabilitation and prosthetic strategies and speculate on factors that may have contributed to their successes and failures. Outcomes. The client survived 12 years after the HCP and returned to independent mobility, self-care, and schooling despite complications with continued skin breakdown. Over the 12 years following discharge from the hospital after the spinal cord injury, he spent 749 days in the hospital. During the 12 years he lived after discharge from the hospital following the HCP, he was hospitalized 190 days. Discussion. The authors discuss factors contributing to the client's musculoskeletal deterioration including chronic wounds, postural deviations, and incomplete adherence to pressure-relief recommendations and raise considerations for physical therapists who treat patients after HCP.
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Vorobyov, A. I., and V. G. Porokhin. "Use of a universal external fixation device in the treatment of bedsores in patients with complicated spinal injury by skeletal suspension." N.N. Priorov Journal of Traumatology and Orthopedics 4, no. 3 (July 29, 1997): 63–64. http://dx.doi.org/10.17816/vto108567.
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Davern, Monica Salazar, Sumeet Garg, and Todd C. Hankinson. "Operative management of traumatic cervical spine distraction and complete cord transection in a 3-year-old patient." Journal of Neurosurgery: Pediatrics 15, no. 2 (February 2015): 214–19. http://dx.doi.org/10.3171/2014.10.peds14242.
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This report describes the presentation and operative treatment of a 3-year-old boy who survived a motor vehicle accident that resulted in a C6–7 distraction injury, complete avulsion of the spinal cord, and gross spinal instability. Only 5%–10% of all spinal cord and vertebral column injuries occur in children. Survival after such an injury is exceptionally rare in very young patients and is associated with severe neurological deficits. The authors discuss the substantial ethical challenges involved in the care of a patient with this injury. To their knowledge, only two other cases of survival have been reported in pediatric patients following motor vehicle trauma resulting in complete injury to the lower cervical spinal cord.
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Piatt, Joseph H., and Mary Steinberg. "Isolated Spinal Cord Injury as a Presentation of Child Abuse." Pediatrics 96, no. 4 (October 1, 1995): 780–82. http://dx.doi.org/10.1542/peds.96.4.780.
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Many, if not most, instances of severe head trauma in infancy are attributable to child abuse. Thorough post mortem examination demonstrates upper cervical spinal cord lesions in a substantial fraction of infants who die of their head injuries,1 but these spinal cord injuries are seldom recognized ante mortem. Spinal column fractures have been described as incidental findings in the setting of child abuse, but they are seldom apparent clinically.2 Spinal cord injury without spinal fracture and without head injury is a rare presentation of child abuse, and the true nature of this syndrome may escape recognition unless other characteristic signs of abuse are detected.
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Mohit, A. Alex, Sohail Mirza, Jennifer James, and Robert Goodkin. "Charcot arthropathy in relation to autonomic dysreflexia in spinal cord injury." Journal of Neurosurgery: Spine 2, no. 4 (April 2005): 476–80. http://dx.doi.org/10.3171/spi.2005.2.4.0476.
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✓ Charcot spinal arthropathy has been described as a late complication of spinal cord injury. In patients with these injuries in whom the spine below the level of injury is insensate, joint trauma can progress until spinal instability ensues. The authors describe the case of a 50-year-old man with complete C-8 tetraplegia who experienced a 4-month history of episodic severe headaches, profuse sweating over his face and arms, and episodic severe hypertension in addition to a “grinding” sensation in the lower back. Charcot arthropathy at the T11–12 levels with pathological mobility was demonstrated on neuroimaging. Intraoperatively, a complete spinal cord transection was identified. Anterior and posterior thoracolumbar fusion across the mobile segment resulted in complete amelioration of signs and symptoms of autonomic dysreflexia. This entity, a common condition in the setting of spinal cord injury, has many triggers. Definitive treatment is targeted at the removal of the underlying cause. As demonstrated here, Charcot spinal arthropathy can act as a powerful trigger for induction of autonomic dysreflexia. Treatment of the associated spinal instability resulted in eradication of all signs and symptoms of the dysreflexia.
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Janjua, Tariq, Scott Myer, and Luis Rafael Moscote-Salazar. "Spinal Cord Reperfusion Injury after Decompression of Severe Cord Compression: Critical Care Management." Journal of Neurointensive Care 5, no. 1 (April 30, 2022): 36–37. http://dx.doi.org/10.32587/jnic.2021.00444.
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Alshorman, Jamal, Yulong Wang, Fengzhao Zhu, Lian Zeng, Kaifang Chen, Sheng Yao, Xirui Jing, Yanzhen Qu, Tingfang Sun, and Xiaodong Guo. "Medical Communication Services after Traumatic Spinal Cord Injury." Journal of Healthcare Engineering 2021 (August 31, 2021): 1–11. http://dx.doi.org/10.1155/2021/4798927.
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It is difficult to assess and monitor the spinal cord injury (SCI) because of its pathophysiology after injury, with different degrees of prognosis and various treatment methods, including laminectomy, durotomy, and myelotomy. Medical communication services with different factors such as time of surgical intervention, procedure choice, spinal cord perfusion pressure (SCPP), and intraspinal pressure (ISP) contribute a significant role in improving neurological outcomes. This review aims to show the benefits of communication services and factors such as ISP, SCPP, and surgical intervention time in order to achieve positive long-term outcomes after an appropriate treatment method in SCI patients. The SCPP was found between 90 and 100 mmHg for the best outcome, MAP was found between 110 and 130 mmHg, and mean ISP is ≤20 mmHg after injury. Laminectomy alone cannot reduce the pressure between the dura and swollen cord. Durotomy and duroplasty considered as treatment choices after severe traumatic spinal cord injury (TSCI).
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Novoselova, Irina N., Irina V. Ponina, Olga V. Popova, Aleksander V. Kalyuzhny, Ilia A. Melnikov, and Svetlana A. Valiullina. "Diagnostic Errors of Spinal Cord Injuries in Children with Combined Trauma on the example of Clinical Cases." Bulletin of Rehabilitation Medicine 20, no. 4 (August 31, 2021): 106–14. http://dx.doi.org/10.38025/2078-1962-2021-20-4-106-114.
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Diagnostic errors of spinal cord injuries with combined trauma in children are facilitated by the patient’s age, which does not allow foran adequate neurological assessment of motor and sensitive disorders, a reduced state of consciousness in severe traumatic brain injury,the lack of modern methods of neuroimaging in primary hospitals, insufficient qualifications and experience of medical personnel. Aim. To demonstrate outcomes of diagnostic errors in traumatic spinal cord injury in children on clinical examples of two patients. Material and methods. The object of observation was children with severe combined trauma, whose post-traumatic spinal cord injurywas missed in the primary hospital. To diagnose the current condition, the following were used: clinical examination with a neurologicalassessment on the ASIA scale, assessment of motor functioning, laboratory monitoring, instrumental examination, ultrasoundmonitoring, X-ray, MRI, CT, CT densitometry, ECG, echocardiography, USDG. In addition, neuropsychological assessment was made so to evaluate cortical functions and to reveal consequences of traumatic brain injury. Results. The cause of errors in the diagnostics of spinal cord injury in children is the underestimation of state severity due to the combinedtype of injury or small age of the child. Conclusion. The experience of the multidisciplinary team of specialists in the diagnosis and medical rehabilitation of children withspinal cord injury missed in the primary hospital indicates the need to conduct a full-fledged neurological examination, CT accordingto the “head to toe” program and MRI, even if there is a slight suspicion of the spinal cord damage.Underestimation of the severity of the child’s condition with concomitant trauma, including spinal cord injury, leads to the deprivationnot only in the motor function restoration, but also to deterioration in the quality of life of the family and to the problems associatedwith patient’s integration into society.
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Gallucci, Antonella, Ludovica Dragone, Tania Al Kafaji, Marika Menchetti, Sara Del Magno, and Gualtiero Gandini. "Outcome in Cats with Acute Onset of Severe Thoracolumbar Spinal Cord Injury Following Physical Rehabilitation." Veterinary Sciences 8, no. 2 (January 29, 2021): 22. http://dx.doi.org/10.3390/vetsci8020022.
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The literature is lacking data concerning the prognosis in cats suffering from naturally occurring acute onset of thoracolumbar (TL) spinal cord injury that are undergoing rehabilitation therapy. Therefore, we investigated the effect of physical rehabilitation in cats suffering from naturally occurring TL spinal cord injury. The medical records of 36 cats with acute onset of TL spinal cord injury that were selected for rehabilitation treatment were reviewed. Twenty-nine cats underwent an intensive physical rehabilitation protocol in the clinic (group 1), whereas the owners of seven cats declined physical rehabilitation (group 2). In group 1, seven cats had pelvic limb deep pain perception (DPP), which was significantly associated with the functional recovery of voluntary ambulatory status (p = 0.010) and voluntary micturition (p < 0.001). Spinal walking was achieved in 10/22 (45%) of the cats without DPP, and none regained voluntary micturition. In group 2, no cats regained ambulatory status or voluntary micturition, although pelvic limb DPP was present in three patients. Treatment with a clinic-based rehabilitation program and the presence of a crossed extensor reflex were significantly associated with a higher possibility of regaining functional ambulatory status (p < 0.010), but there was no difference in the recovery of voluntary micturition between the groups. Thus, cats with severe, naturally occurring, acute onset of TL spinal cord injury may benefit from physical rehabilitation. In the case of the loss of DPP, the acquisition of spinal walking is possible, despite the high possibility of a persistent neurologically dysfunctional bladder.
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Jalan, Devesh, Neginder Saini, Mohammad Zaidi, Alexandra Pallottie, Stella Elkabes, and Robert F. Heary. "Effects of early surgical decompression on functional and histological outcomes after severe experimental thoracic spinal cord injury." Journal of Neurosurgery: Spine 26, no. 1 (January 2017): 62–75. http://dx.doi.org/10.3171/2016.6.spine16343.
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OBJECTIVE In acute traumatic brain injury, decompressive craniectomy is a common treatment that involves the removal of bone from the cranium to relieve intracranial pressure. The present study investigated whether neurological function following a severe spinal cord injury improves after utilizing either a durotomy to decompress the intradural space and/or a duraplasty to maintain proper flow of cerebrospinal fluid. METHODS Sixty-four adult female rats (n = 64) were randomly assigned to receive either a 3- or 5-level decompressive laminectomy (Groups A and B), laminectomy + durotomy (Groups C and D), or laminectomy + duraplasty with graft (Group E and F) at 24 hours following a severe thoracic contusion injury (200 kilodynes). Duraplasty involved the use of DuraSeal, a hydrogel dural sealant. Uninjured and injured control groups were included (Groups G, H). Hindlimb locomotor function was assessed by open field locomotor testing (BBB) and CatWalk gait analysis at 35 days postinjury. Bladder function was analyzed and bladder wall thickness was assessed histologically. At 35 days postinjury, mechanical and thermal allodynia were assessed by the Von Frey hair filament and hotplate paw withdrawal tests, respectively. Thereafter, the spinal cords were dissected, examined for gross anomalies at the injury site, and harvested for histological analyses to assess lesion volumes and white matter sparing. ANOVA was used for statistical analyses. RESULTS There was no significant improvement in motor function recovery in any treatment groups compared with injured controls. CatWalk gait analysis indicated a significant decrease in interlimb coordination in Groups B, C, and D (p < 0.05) and swing speed in Groups A, B, and D. Increased mechanical pain sensitivity was observed in Groups A, C, and F (p < 0.05). Rats in Group C also developed thermal pain hypersensitivity. Examination of spinal cords demonstrated increased lesion volumes in Groups C and F and increased white matter sparing in Group E (p < 0.05). The return of bladder automaticity was similar in all groups. Examination of the injury site during tissue harvest revealed that, in some instances, expansion of the hydrogel dural sealant caused compression of the spinal cord. CONCLUSIONS Surgical decompression provided no benefit in terms of neurological improvement in the setting of a severe thoracic spinal cord contusion injury in rats at 24 hours postinjury. Decompressive laminectomy and durotomy did not improve motor function recovery, and rats in both of these treatment modalities developed neuropathic pain. Performing a durotomy also led to increased lesion volumes. Placement of DuraSeal was shown to cause compression in some rats in the duraplasty treatment groups. Decompressive duraplasty of 3 levels does not affect functional outcomes after injury but did increase white matter sparing. Decompressive duraplasty of 5 levels led to neuropathic pain development and increased lesion volumes. Further comparison of dural repair techniques is necessary.
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Younsi, Alexander, Guoli Zheng, Lennart Riemann, Moritz Scherer, Hao Zhang, Mohamed Tail, Maryam Hatami, Thomas Skutella, Andreas Unterberg, and Klaus Zweckberger. "Long-Term Effects of Neural Precursor Cell Transplantation on Secondary Injury Processes and Functional Recovery after Severe Cervical Contusion-Compression Spinal Cord Injury." International Journal of Molecular Sciences 22, no. 23 (December 3, 2021): 13106. http://dx.doi.org/10.3390/ijms222313106.
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Cervical spinal cord injury (SCI) remains a devastating event without adequate treatment options despite decades of research. In this context, the usefulness of common preclinical SCI models has been criticized. We, therefore, aimed to use a clinically relevant animal model of severe cervical SCI to assess the long-term effects of neural precursor cell (NPC) transplantation on secondary injury processes and functional recovery. To this end, we performed a clip contusion-compression injury at the C6 level in 40 female Wistar rats and a sham surgery in 10 female Wistar rats. NPCs, isolated from the subventricular zone of green fluorescent protein (GFP) expressing transgenic rat embryos, were transplanted ten days after the injury. Functional recovery was assessed weekly, and FluoroGold (FG) retrograde fiber-labeling, as well as manganese-enhanced magnetic resonance imaging (MEMRI), were performed prior to the sacrifice of the animals eight weeks after SCI. After cryosectioning of the spinal cords, immunofluorescence staining was conducted. Results were compared between the treatment groups (NPC, Vehicle, Sham) and statistically analyzed (p < 0.05 was considered significant). Despite the severity of the injury, leading to substantial morbidity and mortality during the experiment, long-term survival of the engrafted NPCs with a predominant differentiation into oligodendrocytes could be observed after eight weeks. While myelination of the injured spinal cord was not significantly improved, NPC treated animals showed a significant increase of intact perilesional motor neurons and preserved spinal tracts compared to untreated Vehicle animals. These findings were associated with enhanced preservation of intact spinal cord tissue. However, reactive astrogliosis and inflammation where not significantly reduced by the NPC-treatment. While differences in the Basso–Beattie–Bresnahan (BBB) score and the Gridwalk test remained insignificant, animals in the NPC group performed significantly better in the more objective CatWalk XT gait analysis, suggesting some beneficial effects of the engrafted NPCs on the functional recovery after severe cervical SCI.
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Shroff, Geeta. "Magnetic resonance imaging tractography as a diagnostic tool in patients with spinal cord injury treated with human embryonic stem cells." Neuroradiology Journal 30, no. 1 (January 6, 2017): 71–79. http://dx.doi.org/10.1177/1971400916678221.
Full textAbstract:
Introduction Spinal cord injury is a cause of severe disability and mortality. The pharmacological and non-pharmacological methods used, are unable to improve the quality of life in spinal cord injury. Spinal disorders have been treated with human embryonic stem cells. Magnetic resonance imaging and tractography were used as imaging modality to document the changes in the damaged cord, but the magnetic resonance imaging tractography was seen to be more sensitive in detecting the changes in the spinal cord. The present study was conducted to evaluate the diagnostic modality of magnetic resonance imaging tractography to determine the efficacy of human embryonic stem cells in chronic spinal cord injury. Materials and methods The study included the patients with spinal cord injury for whom magnetic resonance imaging tractography was performed before and after the therapy. Omniscan (gadodiamide) magnetic resonance imaging tractography was analyzed to assess the spinal defects and the improvement by human embryonic stem cell treatment. The patients were also scored by American Spinal Injury Association scale. Results Overall, 15 patients aged 15–44 years with clinical manifestations of spinal cord injury had magnetic resonance imaging tractography performed. The average treatment period was nine months. The majority of subjects ( n = 13) had American Spinal Injury Association score A, and two patients were at score C at the beginning of therapy. At the end of therapy, 10 patients were at score A, two patients were at score B and three patients were at score C. Improvements in patients were clearly understood through magnetic resonance imaging tractography as well as in clinical signs and symptoms. Conclusion Magnetic resonance imaging tractography can be a crucial diagnostic modality to assess the improvement in spinal cord injury patients.
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Shi, Riyi, and Richard B. Borgens. "Acute Repair of Crushed Guinea Pig Spinal Cord by Polyethylene Glycol." Journal of Neurophysiology 81, no. 5 (May 1, 1999): 2406–14. http://dx.doi.org/10.1152/jn.1999.81.5.2406.
Full textAbstract:
Acute repair of crushed guinea pig spinal cord by polyethylene glycol. We have studied the responses of adult guinea pig spinal cord white matter to a standardized compression within a sucrose gap recording chamber. This injury eliminated compound action potential (CAP) conduction through the lesion, followed by little or no recovery of conduction by 1 h postinjury. We tested the ability of polyethylene glycol (PEG) to repair the injured axons and restore physiological function. Local application of PEG (1,800 MW, 50% by weight in water) for ∼2 min restored CAP conduction through the injury as early as 1 min post PEG application. The recovery of the CAP ≤1 h was significantly greater in treated compared with control spinal cords (controls = 3.6% of the preinjury amplitude; PEG treated = 19%; P < 0.0001, unpaired Student’s t-test). Stimulus-response analysis indicated that the susceptibility for recovery was similar for all calibers of axons after PEG application. The enhanced recovery of conduction after PEG treatment was associated with an early alteration in conduction properties relative to control spinal cords. This included increased refractoriness and sensitivity to potassium channel blockade using 4-aminopyridine (4-AP). Normally 4-AP enhanced the amplitude of the recovering CAPs by ∼40% in control spinal cords; however this effect was nearly doubled to ∼72% in PEG treated spinal cords. Because severe clinical injuries to the spinal cord (and some peripheral nerves) are both resistant to medical treatment and usually produced by compression, we discuss the possible clinical benefits of PEG application.