Journal articles on the topic 'Spinal cord – Wounds and injuries'
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Slynko, Ievgenii I., Yurii V. Derkach, Arthur I. Ermolev, Oleksii S. Nekhlopochyn, and David A. Tavzadze. "Mine blast injury of the spine and spinal cord: a case report." Ukrainian Neurosurgical Journal 28, no. 2 (June 24, 2022): 54–56. http://dx.doi.org/10.25305/unj.257985.
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Many soldiers who were wounded during the war in Ukraine with Russia increased the number of cases of spinal injury. As a result of the Russia-Ukraine war, the number of patients with spine and spinal cord injuries increased significantly. According to the literature, gunshot wounds to the spine and spinal cord accounted for 0.26% of all soldier injuries during the American Civil War, with a mortality rate of 55%. According to the U.S. military data, spinal and spinal cord injuries accounted for 1.2% of war-related deaths during the Korean War, 1.0% - during the Vietnam War and the Gulf War, 6.0% - during the US invasion of Panama, 11.1% - during the war in Afghanistan and Iraq. Disability related to spinal cord injuries (14.0%) is currently the leading cause of discharge from military service for U.S. soldiers who have been injured. Patient M., 32 years old, male sustained mine blast injury. Immediately after the injury there was tetraplegia. Surgery was performed to correct vertebrae С7–Тh1, decompression of the spinal cord at the level of vertebrae С7–Тh1. Sixteen days after surgery, the neurological deficit regressed to the Frankel C clinical group. The patient was transferred to rehabilitation treatment. A clear, consistent, rapid algorithm of action in spinal cord injuries allowed to provide highly qualified care, which allowed to achieve significant results in the regression of neurological deficits in the postoperative period.
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Williams, David T., Danny L. Chang, and Matthieu P. DeClerck. "Penetrating spinal cord injuries with retained canal fragments." CJEM 11, no. 02 (March 2009): 172–73. http://dx.doi.org/10.1017/s1481803500011155.
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Case 1: A previously healthy 15-year-old boy was brought by paramedics to the emergency department (ED) after suffering multiple penetrating gunshot wounds (GSWs) to the lower extremities and a single entry to the left suprascapular region. Vital signs were within normal limits upon presentation. Case 2: A previously healthy 19-year-old man was brought by paramedics to the ED after suffering multiple stab wounds to the back. The patient was hypoxic and in severe respiratory distress upon arrival. A left thoracostomy tube was placed. Clinically the patient improved and vital signs returned to normal.
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Waters, Robert L., and Ien H. Sie. "Spinal Cord Injuries From Gunshot Wounds to the Spine." Clinical Orthopaedics and Related Research 408 (March 2003): 120–25. http://dx.doi.org/10.1097/00003086-200303000-00014.
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Benzel, Edward C., Theresa A. Hadden, and James Edward Coleman. "Civilian Gunshot Wounds to the Spinal Cord and Cauda Equina." Neurosurgery 20, no. 2 (February 1, 1987): 281–85. http://dx.doi.org/10.1227/00006123-198702000-00014.
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Abstract We evaluated 42 patients with neurological deficits after civilian gunshot wounds to the spine. Thirty-five of these patients (the study population presented here) received their initial and follow-up care at Louisiana State University Medical Center in Shreveport over a 4-year period. Each patient had incurred a single gunshot wound to the spinal cord or cauda equina with an accompanying neurological deficit. The patient population was divided into three groups. Group 1 patients had incurred a complete motor and sensory loss below the injury (20 patients (57%)). Group 2 patients had incurred incomplete spinal cord injuries (9 patients (26%)), whereas Group 3 patients had cauda equina injuries (6 patients (17%)). Myelography was performed for all Group 2 and 3 patients as well as Group 1 patients in whom the trajectory of the bullet did not explain a higher level of neurological injury (3 patients (15%)). A decompressive operation was performed in the patients whose myelography showed neural compression. Three patients in Group 1 (15%), 5 patients in Group 2 (56%), and 5 Group 3 patients (83%) underwent operation. All 3 Group 1 patients who underwent operation had some improvement of nerve root function postoperatively. All operated Group 2 and 3 patients had improvement of myelopathic or radicular function postoperatively. All began improving within several days of operation, implying a cause and effect relationship. None of the 17 nonoperated Group 1 patients improved neurologically, whereas 3 of the 4 nonoperated Group 2 patients improved. The single nonoperated Group 3 patient improved neurologically. It is concluded that patients with incomplete neurological injuries after civilian gunshot wounds to the spine can expect radicular or myelopathic improvement. Decompressive operation is indicated in selected cases with unexpected radicular injuries or incomplete myelopathic injuries with myelographic evidence of neural compression. A stepwise improvement in neurological function over that expected without operation should be realized in these cases.
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Ortiz, A. O., R. R. Patel, R. F. Riascos, M. Castillo, J. Hochsztein, R. Sacchi, and S. Khanpara. "More Than Meets the Eye: Additional Insights on Trajectory Analysis in Penetrating Spine Trauma." Neurographics 10, no. 5 (October 1, 2020): 247–58. http://dx.doi.org/10.3174/ng.2000014.
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Penetrating spine trauma presents a major challenge to clinical management. By using standard and cross-sectional imaging modalities, radiologists should be able to perform a trajectory analysis of the penetrating object and identify the path of injury as well as those structures that were injured along that path. Toward this end, we conducted a multi-institutional retrospective review of 23 patients who had penetrating spine trauma due to either a gunshot or stab wound and who, subsequently, underwent cross-sectional imaging with CT and/or MR imaging. Two patterns of imaging findings were associated with the penetrating spine trauma. Assault-related gunshot wounds accounted for most of penetrating spine trauma (83%) and were frequently associated with spinal cord injuries, and tended to be associated with other visceral and/or vascular injuries. Stabbing injuries, although less common (17%), were associated with focal spinal cord injuries and with fewer extraspinal injuries. These imaging finding patterns may assist in the evaluation of the imaging examinations, with implications for the extent of injury and prognosis for neurologic recovery, and, when necessary, can contribute to forensic analysis.Learning Objective: To identify the imaging findings and understand the value of trajectory analysis and its implications in projectile- and nonprojectile-penetrating spine trauma.
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Binsuwaidan, Reem, Mohammad Aatif Khan, Raghad H. Alzahrani, Aljoharah M. Aldusaymani, Noura M. Almallouhi, Alhanouf S. Alsabti, Sajjad Ali, Omar Sufyan Khan, Amira M. Youssef, and Lina I. Alnajjar. "Prevalence of Multidrug-Resistant and ESBL-Producing Bacterial Pathogens in Patients with Chronic Wound Infections and Spinal Cord Injury Admitted to a Tertiary Care Rehabilitation Hospital." Antibiotics 12, no. 11 (November 2, 2023): 1587. http://dx.doi.org/10.3390/antibiotics12111587.
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A pressure ulcer is defined as a skin lesion of ischemic origin, a condition that contributes to morbidity and mortality in patients with spinal cord injuries. The most common complication of ulcers is a bacterial infection. Antimicrobial therapy should be selected with caution for spinal cord injury patients since they have a high risk of developing multidrug-resistant (MDR) infections. The aim of this study was to determine the prevalence of different bacterial pathogens in patients with pressure ulcers admitted with spinal cord injuries. This was a retrospective single-center study that included adult patients aged 18 years and above, admitted with chronic pressure wounds after a spinal cord injury requiring hospitalization between 2015 and 2021. A total of 203 spinal cord injury patients with pressure ulcers were included in the study. Ulcers were commonly infected by Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli, and they were mostly located in the sacral and gluteal areas. More than half of the bacteria isolated from patients were sensitive to commonly tested antibiotics, while 10% were either MDR- or pan-drug-resistant organisms. Of the MDR bacterial isolates, 25.61% were methicillin-resistant S. aureus, and 17.73% were extended-spectrum beta-lactamase Enterobacteriaceae. The most prevalent bacteria in pressure ulcers of spinal cord injury patients were S. aureus. Other antibiotic-resistant organisms were also isolated from the wounds.
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Bagheri, Zahra, Amir Larki-Harchegani, Shabnam Pourmoslemi, Amir Nili-Ahmadabadi, Ebrahim Bakhtiari, Hamid Safarpour, Ali Fathi Jouzdani, and Morteza Shamsizadeh. "The Antimicrobial and Healing Effect of Scrophularia striata Boiss Hydroalcoholic Extract on First- and Second-Grade Pressure Wounds in Patients with Brain and Spinal Cord Injury: A Randomized Clinical Trial." Evidence-Based Complementary and Alternative Medicine 2022 (November 28, 2022): 1–11. http://dx.doi.org/10.1155/2022/8522937.
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Introduction and Objectives. Pressure wound is one of the most common problems in patients with brain and spinal cord lesions leading to complications such as severe pain, infection, and frequent hospitalisation. The present study aimed to determine the restorative and antimicrobial effects of Scrophularia striata hydroalcoholic extract (SHE) on first- and second-grade pressure ulcers in patients with brain and spinal cord lesions. Materials and Methods. This double-blind clinical trial study was performed on grade 1 and 2 pressure wounds in 120 patients with cerebral-spinal cord lesions. The patients were randomly divided into four groups (n = 30). Topical treatments in all groups were performed twice a day. These groups included experiment 1 (SHE + phenytoin), experiment 2 (SHE + SHE), control (phenytoin + phenytoin), and placebo (eucerin + phenytoin). After evaluating the effect of SHE on wound healing, its antibacterial activity was determined by the standard agar well diffusion method. Results. Patients in each group in this study did not significantly differ in demographic and clinical variables. Complete wound healing by the 10th day of the intervention occurred in 63%, 100%, and 27% of patients in experimental 1, experimental 2, and control groups, respectively. In contrast, the placebo group had no complete wound healing until the 10th day. Topical application of SHE, twice a day in the experimental 2 groups, had a higher potency to heal wounds and reduce the duration of complete wound healing in patients compared with other groups. Conclusion. SHE, as a novel treatment option, has good potential to accelerate the healing of first- and second-degree pressure wounds in patients with brain-spinal cord injuries.
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Galili, Uri, Jianming Li, and Gary L. Schaer. "Regeneration in Mice of Injured Skin, Heart, and Spinal Cord by α-Gal Nanoparticles Recapitulates Regeneration in Amphibians." Nanomaterials 14, no. 8 (April 22, 2024): 730. http://dx.doi.org/10.3390/nano14080730.
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The healing of skin wounds, myocardial, and spinal cord injuries in salamander, newt, and axolotl amphibians, and in mouse neonates, results in scar-free regeneration, whereas injuries in adult mice heal by fibrosis and scar formation. Although both types of healing are mediated by macrophages, regeneration in these amphibians and in mouse neonates also involves innate activation of the complement system. These differences suggest that localized complement activation in adult mouse injuries might induce regeneration instead of the default fibrosis and scar formation. Localized complement activation is feasible by antigen/antibody interaction between biodegradable nanoparticles presenting α-gal epitopes (α-gal nanoparticles) and the natural anti-Gal antibody which is abundant in humans. Administration of α-gal nanoparticles into injuries of anti-Gal-producing adult mice results in localized complement activation which induces rapid and extensive macrophage recruitment. These macrophages bind anti-Gal-coated α-gal nanoparticles and polarize into M2 pro-regenerative macrophages that orchestrate accelerated scar-free regeneration of skin wounds and regeneration of myocardium injured by myocardial infarction (MI). Furthermore, injection of α-gal nanoparticles into spinal cord injuries of anti-Gal-producing adult mice induces recruitment of M2 macrophages, that mediate extensive angiogenesis and axonal sprouting, which reconnects between proximal and distal severed axons. Thus, α-gal nanoparticle treatment in adult mice mimics physiologic regeneration in amphibians. These studies further suggest that α-gal nanoparticles may be of significance in the treatment of human injuries.
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Eftekhary, Nima, Kenneth Nwosu, Eric McCoy, Dudley Fukunaga, and Kevin Rolfe. "Overutilization of bracing in the management of penetrating spinal cord injury from gunshot wounds." Journal of Neurosurgery: Spine 25, no. 1 (July 2016): 110–13. http://dx.doi.org/10.3171/2015.12.spine151022.
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OBJECTIVE Penetrating gunshot wounds (GSWs) to the spinal column are stable injuries and do not require spinal orthoses or bracing postinjury. Nonetheless, a high number of GSW-related spinal cord injury (SCI) patients are referred with a brace to national rehabilitation centers. Unnecessary bracing may encumber rehabilitation, create skin breakdown or pressure ulcers, and add excessive costs. The aim of this study was to confirm the stability of spinal column injuries from GSWs and quantify the overutilization rate of bracing based on long-term follow-up. METHODS This retrospective cohort study was performed at a nationally renowned rehabilitation center. In total, 487 GSW-related SCI patients were transferred for rehabilitation and identified over the last 14 years. Retrospective chart review and telephone interviews were conducted to identify patients who were braced at the initial treating institution and determine if late instability, deformity, or neurological deterioration resulted in secondary surgery or intervention. In addition, 396 unoperated patients were available for analysis after 91 patients were excluded for undergoing an initial destabilizing surgical dissection or laminectomy, thereby altering the natural history of the injury. All of these 396 patients who presented with a brace had bracing discontinued upon reaching the facility. RESULTS In total, 203 of 396 patients were transferred with a spinal brace, demonstrating an overutilization rate of 51%. No patients deteriorated neurologically or needed later surgery for spinal column deformity or instability attributable to the injury. All patients had stable injuries. The patterns of injury and severity of neurological injury did not vary between patients who were initially braced or unbraced. The average follow-up was 7.8 years (range 1–14 years) and the average age was 25 years (range 10–62 years). CONCLUSIONS The incidence of brace overutilization for penetrating GSW-related SCI was 51%. Long-term follow-up in this study confirmed that these injuries were stable and thus did not require bracing. No patients deteriorated neurologically, whether or not they were initially braced. The unnecessary use of spinal orthoses increases costs and patient morbidity. Reeducation and dissemination of this information is warranted.
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Corr, Peter, and Hoosen Lakhi. "MR imaging of penetrating spinal trauma." South African Journal of Radiology 7, no. 3 (August 31, 2003): 25–29. http://dx.doi.org/10.4102/sajr.v7i3.1393.
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Objective: To determine the utility of MR imaging in the assessment of spinal cord injury following penetrating spinal trauma.Methods: We retrospectively reviewed the case notes and MR studies of patients referred to our MR facility over a 2-year period with neurological deficits following penetrating spinal injuries. All MR studies were performed on the same MR scanner with identical protocols. We reviewed the MR studies blinded to the clinical data and MR reports. We recorded the presence of: spinal cord transection, cord contusion, haematomyelia, extramedullary haematoma and vascula injury.Results: 20 patients (17 males, 3 females) with a mean age of 28 years were studied. Causes of injury were knife wounds in 17 patients and gun shot wounds in 3 patients. Site of injury was: cervical in 14, thoracic 4, lumbar in 2. Neurological deficits were: Brown-Séquard syndrome in 8, paraparesis in 7, quadraparesis in 2, hemiplegia 2, unconscious 1. MR findings were: partial cord transection in 9 patients, cord oedema/contusion in 5, haematomyelia in 2, myelomalacia in 2, and disk herniation in 1. One patient with cord transection sustained verterbral artery occlusion. Only 4 patients with Brown-Séquardsyndrome had partial cord transection, the other 5 had cord contusions.Conclusions: MR accurately demonstrates spinal cord injury in patients with penetrating spinal trauma, however the clinical signs detected do not always correlate with the MR findings.
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Kozachenko, Ihor. "Nonfatal air gun shot trauma: structural analysis and morphological features injuries." Forensic-medical examination, no. 2 (December 30, 2016): 47–51. http://dx.doi.org/10.24061/2707-8728.2.2016.10.
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In practical activities of the Ukrainian bureau of forensic we increasingly come across cases of nonfatal air gun injuries. However, experts lack a common methodological approaches for forensic evaluation of injuries, particularly during the examination of living people. An earlier analysis of nonfatal air gun injuries made on materials of only two regional bureau of forensic medical examination, a purely local nature used on a small number of cases using some general parameters can provide processing methodology study of air gun injuries and practical recommendations for the implementation of forensic medical examinations. 127 cases of «Expert’s conclusions» and «Acts of the forensic examination» were investigated, taken from 21 bureaus all regions of Ukraine during the period of 2006-2015, in which was performed forensic medical examinations in cases nonfatal air guns injuries.Discussion. The main causes of nonfatal air gun injuries are named as hooliganism, domestic conflicts, careless handling of weapons and robbery. Among the injured men is 86 %, women – 14 %. Injuries made mostly of air pistols and rifles, caliber 4.5mm. Among the weapons 8 models applied rifles large and extra large capacity. Most commonlywounded parts were head (38 %), chest (17,3 %) and lower limbs (16 %), less common – upper limbs (10,2 %) and neck (3,9 %). Input air gun injuries are mainly wounds (74 %), sometimes abrasions (23 %) and bruising (3 %). The nature and volume air gun injuries primarily dependent on the power of the applied weapon and the affected areas of the body, penetrating wounds from shots of powerful guns are accompanied by injuries of the brain and spinal cord, internal organsof the chest and abdomen bleedings, fractures of the skull, vertebrae, ribs and scapula; of shots from pistols and rifles low penetrating injuries were observed only in the cranial cavity, mostly after bullet passing an eyeball.Conclusions:1. The main causes of nonfatal air gun shot trauma were hooliganism, domestic violence, accidents and robberies. Among the casualties men is 86 %, women – 14 %.2. Injuries made mostly of air pistols and rifles, caliber 4.5mm including extra large power rifles.3. Most cases provided head, chest and lower limbs wounds, fewer cases of upper limbs and neck injuries were observed.4. High and extra large power rifles more caused penetrating air gunshot wounds of major body cavities with injury to the brain and spinal cord, internal organs with hemorrhages and bone fractures. Pistols and low power rifles caused penetrating injuries only in the cranial cavity, commonly after passing projectile eyeball.5. The majority of wounds are defined as minor injuries. Injuries of moderate severity made up only 2%. Serious injuries attributed to 13% according hazard to life and complete loss of sight.
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Antonov, G. I., V. A. Manukovskiy, G. E. Chmutin, I. I. Ivanov, S. Yu Timonin, and A. O. Kelin. "Analysis of treatment outcomes in patients with combat spinal column and spinal cord injuries." Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery), no. 11 (November 27, 2023): 912–21. http://dx.doi.org/10.33920/med-01-2311-06.
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Introduction. Spinal column and spinal cord injuries are one of the most severe types of trauma. The paper presents the results of examination and treatment of 80 patients with combat spinal column and spinal cord injuries treated in the neurosurgical department of the FSBI National Medical Research Center for High Medical Technologies — A. A. Vishnevsky Central Military Clinical Hospital. Purpose. To analyze the structure of incoming wounded patients and the results of treatment of patients with combat spinal injury in the conditions of a multidisciplinary medical center. Materials and methods. The paper analyzes the results of treatment of 80 patients with combat spinal column and spinal cord injuries treated in the Neurosurgery Center, FSBI National Medical Research Center for High Medical Technologies — A. A. Vishnevsky Central Military Clinical Hospital. The inclusion criteria were the radiological signs of combat spinal injury upon admission to the hospital. Upon admission, all patients underwent pan CT scan, their somatic and neurological status was assessed, and laboratory parameters were evaluated. Gunshot wounds were found in 66.25 % (n=53) of the patients, and blunt combat injuries to the spine were found in 33.75 % (n=17). Concomitant injuries were sustained by 81.25 % (n=65) of the studied patients. Prior to admission to the Neurosurgery Center, neurosurgical care was provided to some of the wounded. Spinal surgery was performed in 30.0 % (n=24) of the cases, and 56.25 % (n=45) were operated on for injuries to other anatomical regions and organ systems. Results. 69 % (n=55) of the patients underwent neurosurgical treatment. The indication for surgery in 56.4 % (n=31) of the patients was instability in the spinal motion segment (SMS). Both one-stage (anterior or posterior stabilization) and two-stage operations consisting of posterior and anterior approaches, including with the use of minimally invasive techniques (8 cases), were performed. In 23 patients, foreign body removal was performed, including by means of videoimage endoscopy (in 5 cases). On average, the wounded had an operation on the 5th day after the injury. At discharge, motor neurological improvement or complete recovery was seen in 21.1 % (n=16) of the patients, while motor disorders remained at the initial level in 78.9 % (n=60). Sensory disorders decreased in 13.1 % (n=10), while 84.2 % (n=64) showed no improvement in sensory level. There was a significant decrease in the intensity of the pain syndrome. However, the number of patients with neuropathic pain decreased slightly (41 patients among all the examined at discharge versus 42 at admission). The functions of the pelvic organs were restored in 8.25 % (n=7) of the patients. At the stage of treatment in the specialized center, 49 % (n=39) of the patients had complications in different organ systems. The mortality rate was 2.5 % (n=2).
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Dokponou, Yao Christian Hugues, Mamoune El Mostarchid, Housni Abderrahmane, Niamien Patrice Koffi, Miloudi Gazzaz, and Brahim El Mostarchid. "Spontaneous Recovery of Penetrating Cervical Spinal Cord Injury with Physiotherapeutic Treatment: Case Report and Review of the Literature." Case Reports in Neurological Medicine 2021 (December 26, 2021): 1–5. http://dx.doi.org/10.1155/2021/3741461.
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Stab wounds to the cervical spine are less common than injuries from road accidents, sports injuries, and falls. The presence of vital, vascular, neural, respiratory, and digestive structures in the neck region mean that this kind of spinal injury is generally critical, and its management is a challenge. We report a unique case of a previously healthy 17-year-old adolescent admitted for quadriplegia secondary to a stab wound to the cervical spine at the C4C5 level. There was no surgical indication. The patient underwent physiotherapy. He showed spontaneous neurological improvement two weeks later and was able to sit on his own and to walk about three months of physical rehabilitation.
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Brembilla, Carlo, Luigi Andrea Lanterna, Paolo Gritti, Emanuele Costi, Gianluigi Dorelli, Elena Moretti, and Claudio Bernucci. "Disabling Orthostatic Headache after Penetrating Stonemason Pencil Injury to the Sacral Region." Case Reports in Emergency Medicine 2015 (2015): 1–5. http://dx.doi.org/10.1155/2015/623405.
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Penetrating injuries to the spine, although less common than motor vehicle accidents and falls, are important causes of injury to the spinal cord. They are essentially of two varieties: gunshot or stab wounds. Gunshot injuries to the spine are more commonly described. Stab wounds are usually inflicted by knife or other sharp objects. Rarer objects causing incidental spinal injuries include glass fragments, wood pieces, chopsticks, nailguns, and injection needles. Just few cases of penetrating vertebral injuries caused by pencil are described. The current case concerns a 42-year-old man with an accidental penetrating stonemason pencil injury into the vertebral canal without neurological deficit. After the self-removal of the foreign object the patient complained of a disabling orthostatic headache. The early identification and treatment of the intracranial hypotension due to the posttraumatic cerebrospinal fluid (CSF) sacral fistulae were mandatory to avoid further neurological complications. In the current literature acute pattern of intracranial hypotension immediately after a penetrating injury of the vertebral column has never been reported.
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Alaca, Ridvan, Bilge Yilmaz, Ahmet Salim Goktepe, Kamil Yazicioglu, and Sukru Gunduz. "Military Gunshot Wound-Induced Spinal Cord Injuries." Military Medicine 167, no. 11 (November 1, 2002): 926–28. http://dx.doi.org/10.1093/milmed/167.11.926.
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Martins Araújo, Bruno, Marcela Maria de Almeida Amorim, Sérgio Diego Passos Costa, Nadyne L. F. Cardoso Rocha, Thays G. Rodrigues dos Santos, Rallyson R. F. Barbosa Lopes, Camila Cardoso Diogo, and Eduardo Alberto Tudury. "Spinal cord trauma by air gun projectiles in five cats." Clínica Veterinária XXIII, no. 133 (March 1, 2018): 64–84. http://dx.doi.org/10.46958/rcv.2018.xxiii.n.133.p.64-84.
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Spinal cord trauma induced by ballistic projectiles is considered uncommon in domestic animals, particularly in cats. Outdoor, and indoor-outdoor cats are at greater risk of receiving gunshot wounds. Despite their small size, moderate speed and poor aerodynamic design, projectiles from compressed air guns (pellet guns) can cause severe injury. Treatment and prognosis of animals presented with gun-related injuries can vary considerably, depending on the affected spinal segment location of the lesions, and extent of tissue damage. Due to the unusual occurrence, of this type of trauma in feline patients, the goal of this report is to describe the neurologic, radiographic, and surgical findings in five cats with spinal injury secondary to air gun projectiles.
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Alghamdi, Ibrahim, Naif Bazaie, Naif Alqurashi, and Zubair Ahmed. "The Impact of Prehospital Spinal Immobilization in Patients with Penetrating Spinal Injuries: A Systematic Review and Meta-Analysis." Trauma Care 2, no. 2 (April 26, 2022): 226–37. http://dx.doi.org/10.3390/traumacare2020019.
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Penetrating injuries, such as gunshot or stab wounds, may cause spinal cord injuries and require prehospital spinal immobilization (PHSI) to stabilize the spine. However, the use of PHSI in penetrating spinal injuries remains controversial. This systematic review aimed to investigate the efficacy of prehospital PHSI in patients with penetrating trauma. We systematically searched Google Scholar, Medline (PubMed), The Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE between January 2000 and July 2021. All studies in English that assessed PHSI in patients (>16 years) with penetrating spinal injuries were included. Quality and risk of bias assessments were performed using the modified Newcastle-Ottawa scale. A narrative synthesis and a meta-analysis was conducted. Our search identified 928 studies but only 6 met our inclusion and exclusion criteria. All of the included studies were conducted in the US and the number of patients ranged from 156–75,567 over 3–9 study years. The majority of patients were gunshot or stab wounds. Three studies demonstrated an increased risk of mortality with spinal collars whilst the remaining three studies failed to show any benefits or the benefits remained unproven. All studies were retrospective studies with some risks of bias. This review highlights that the evidence from the literature on PHSI in penetrating trauma outweigh its benefits; thus, its use is discouraged in penetrating spinal trauma. However, further high-quality research is necessary to reach definitive conclusions and to possibly identify suitable alternatives to PHSI for penetrating spinal trauma.
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Hersh, Andrew M., A. Daniel Davidar, Carly Weber-Levine, Divyaansh Raj, Safwan Alomari, Brendan F. Judy, and Nicholas Theodore. "Advancements in the treatment of traumatic spinal cord injury during military conflicts." Neurosurgical Focus 53, no. 3 (September 2022): E15. http://dx.doi.org/10.3171/2022.6.focus22262.
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Significant advancements in the treatment of spinal cord injury (SCI) were developed in the setting of military conflicts, partly due to the large numbers of injuries sustained by service members. No effective SCI treatment options existed into the early 20th century, and soldiers who sustained these injuries were usually considered untreatable. Extensive progress was made in SCI treatment during and after World War II, as physical therapy was increasingly encouraged for patients with SCI, multidisciplinary teams oversaw care, pathophysiology was better understood, and strategies were devised to prevent wound infection and pressure sores. Recent conflicts in Iraq and Afghanistan have caused a substantial rise in the proportion of SCIs among causes of casualties and wounds, largely due to new forms of war and weapons, such as improvised explosive devices. Modern military SCIs resulting from blast mechanisms are substantively different from traumatic SCIs sustained by civilians. The treatment paradigms developed over the past 100 years have increased survival rates and outcomes of soldiers with SCI. In this paper, the authors review the role of military conflicts in the development of therapeutic interventions for SCI and discuss how these interventions have improved outcomes for soldiers and civilians alike.
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Lentscher, Jessica A., Joshua C. Combs, Karrie Walker, Christopher M. Young, and Rebecca Chason. "Postdeployment Fertility Challenges and Treatment in the Modern Era." Seminars in Reproductive Medicine 37, no. 05/06 (September 2019): 239–45. http://dx.doi.org/10.1055/s-0040-1713430.
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AbstractCurrent war-fighting environments have shifted dramatically over the past decade, and with this change, new types of injuries are afflicting American soldiers. Operative Enduring Freedom and Operation Iraqi Freedom have noted an increased use of sophisticated improvised explosive devices by adversaries. Injuries not frequently seen in previous conflict are dismounted complex blast injuries, which involve multiple proximal amputations, pelvic fractures, and extensive perineal wounds. Thus, an unforeseen consequence of the decreased mortality rate after these complex blast injuries is a new wave of U.S. service members facing the challenges of recovering from the catastrophic amputations and genitourinary injuries. New applications of sperm retrieval methods may be used in these specific populations, as they recover and wish to purse family-building goals. Spinal cord injuries, traumatic brain injuries, and considerations unique to the female soldier are explored in this review of urologic care in wounded veterans.
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Rodgers, Ariel, Callie Thompson, Daniel Murphy, Irma Fleming, Giavonni Lewis, Christopher LaChapelle, and Greg Hobson. "566 Posterior Spinal Cord Syndrome after High Voltage Electrical Injury." Journal of Burn Care & Research 44, Supplement_2 (May 1, 2023): S116. http://dx.doi.org/10.1093/jbcr/irad045.161.
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Abstract Introduction High voltage electrical injuries have been called “the grand masquerader”, and significant neurological sequalae have been described. Here, we report the case of a 73-year-old man who sustained a 14.5% total body surface area (TBSA) full thickness electrical burns, most significantly to his scalp (Figure 1). On initial evaluation, there was concern for loss of proprioception resulting in gait instability. A magnetic resonance image (MRI) of the cervical spine performed on post injury day 9 showed no evidence of cervical spinal cord injury. Methods A novel descriptive case report of a high-voltage electrical injury with incomplete spinal cord injury Results The patient underwent several operative interventions for wound coverage and preservation of function with the known challenges experienced with high voltage burn wounds. Despite lack of imaging confirmation, suspicion for an occult neurological injury remained high. Neurological consultation confirmed limited proprioception and loss of 2-point discrimination. Due to these specific findings that resulted in an inability to make significant rehabilitation gains, a subsequent MRI of his cervical spine performed on post-injury day 30 demonstrated T2 hyperintensity in the dorsal column in the cervical spine at the C2-3 and C5-6 levels, suggestive of myelopathy (Figure 2). Conclusions To our knowledge, this is the first reported case of an incomplete spinal cord injury (posterior spinal cord syndrome in this case) due to an electrical injury without bony abnormality the association of paralysis. With the knowledge of this injury, our burn therapists have been able to develop a rehabilitation plan with reasonable expectation and goals. While discussing prognosis with the patient and his family, we noted the absence of data regarding outcomes after injuries of this nature and sought to contribute to the literature with this case. Applicability of Research to Practice A novel case of delayed imaging confirmation of posterior cord syndrome contributes to the body of evidence for neurological sequelae due to electrical injuries.
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Martinez-del-Campo, Eduardo, Leonardo Rangel-Castilla, Hector Soriano-Baron, and Nicholas Theodore. "Magnetic resonance imaging in lumbar gunshot wounds: an absolute contraindication?" Neurosurgical Focus 37, no. 1 (July 2014): E13. http://dx.doi.org/10.3171/2014.7.focus1496.
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Object Performance of MR imaging in patients with gunshot wounds at or near the lumbar spinal canal is controversial. The authors reviewed the literature on the use of MR imaging in gunshot wounds to the spine. They discuss the results from in vitro and clinical studies, analyze the physical properties of common projectiles, and evaluate the safety and indications for MR imaging when metallic fragments are located near the spinal canal. Methods A review of the English-language literature was performed. Data from 25 articles were analyzed, including 5 in vitro studies of the interaction between 95 projectiles and the MR system's magnetic fields, and the clinical outcomes in 22 patients with metallic fragments at or near the spinal canal who underwent MR imaging. Results Properties of 95 civilian and military projectiles were analyzed at a magnet strength of 1, 1.5, 3, and 7 T. The most common projectiles were bullets with a core of lead, either with a copper jacket or unjacketed (73 [76.8%] of 95). Steel-containing (core or jacket) projectiles comprised 14.7%. No field interaction was evident in 78 (96.3%) of the 81 nonsteel projectiles. All steel projectiles showed at least positive deflection forces, longitudinal migration, or rotation. Heating of the projectiles was clinically insignificant. Image artifact was significant in all 9 steel bullets tested, but was not significant in 39 (88.6%) of the 44 nonsteel bullets tested. Overall, 22 patients with complete (82%) and incomplete (14%) spinal cord injury secondary to a projectile lodged inside the spinal canal underwent MR imaging. Discomfort and further physical or neurological deficits were not reported by any patient. Two patients with spinal cord injuries underwent MR imaging studies before surgical decompression and had subsequent, significant neurological improvement. Conclusions Metallic implants near or at the spinal canal are a relative contraindication for MR imaging. However, safe MR imaging might be feasible when a projectile's properties and a patient's individualized clinical presentation are considered.
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Jacobsohn, Martin, Patrick Semple, Robert Dunn, and Sally Candy. "STAB INJURIES TO THE SPINAL CORD." Neurosurgery 61, no. 6 (December 1, 2007): 1262–67. http://dx.doi.org/10.1227/01.neu.0000306105.76259.63.
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Abstract OBJECTIVE This study was undertaken to document changes on magnetic resonance imaging (MRI) scans after a stab to the spinal cord. The aim of the study was to determine if routine MRI scans for this type of injury would lead to a change in management. METHOD All patients with a stab wound to the spinal cord sustained between November 2004 and July 2005 were retrospectively enrolled. All of the patients were examined, a data form was completed, and MRI was performed within 72 hours on arrival at Groote Schuur Hospital. RESULTS Twenty-two patients were imaged during the study period. MRI results were reported by a neuroradiologist. The most common change seen on MRI scans was a spinal cord tract and cord signal change. Other imaging findings that were documented included cord swelling and extra-axial collections. Progressive neurological deficits developed in two patients, both as a result of sepsis. An intramedullary abscess was found on contrast follow-up imaging in only one of the two patients, and this was surgically drained. Five patients had extradural collections visible on MRI scans; however, all of these patients either had complete cord transection on MRI scans at the time of injury or in cases of incomplete injury (Brown Sequard syndrome), a tract was visibly affecting the hemicord that explained the injury and there was no mass effect from the extradural collection. CONCLUSION Routine MRI scans performed on admission of patients with stab injuries to the spinal cord did not lead to surgical intervention unless there was progressive neurological deficit. In such cases, a contrast MRI scan should be performed to rule out sepsis as the most likely cause of deterioration.
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Gidu, Diana Victoria, Elena Valentina Ionescu, Antoanela Oltean, Olivia Carmen Timnea, Carmen Oprea, Alexandra Ecaterina Ciota, Liliana Elena Stanciu, et al. "Incidence of spinal cord injuries in Constanta County (Romania) between 2017-2021." Balneo and PRM Research Journal 14, Vol.14, no.1 (March 27, 2023): 535. http://dx.doi.org/10.12680/balneo.2023.535.
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Background: The purpose of this study was to investigated cases of spinal cord injury (SCI) during the years 2017-2021, in Constanta County (Romania) to update the data on SCI and thus identify the SCI trends in this region of Romania. Methods: The study retrospectively analysed patients with SCI in Constanța County, whose data (medical records) were provided to us by the Romania Motivation Foundation. This analysis was made for the period January 1, 2017 - August 31, 2021. Results: Ninety-six new traumatic cases of SCI were reported between 2017 and 2021 in Constanța County. It was found that the annual incidence is 2.48 per hundred thousand inhabitants. The male / female ratio was 5:1 and the mean age at injury was 33.52 ± 15.1 (33.41 ± 14.80 for men and 33.92 ± 16.01 for women). The most common cause of injury was unintentional fall (48.95%), followed by road accidents (39.58%), stab wounds (4.16%), gunshot wounds (3.12%) and injuries caused by diving 2.08%). Fifteen patients (15.62%) were quadriplegic, and 81 patients (84.37%) were paraplegic. The most common level of lesions was C4 (33.33%) in tetraplegics and T12 (25.92%) in paraplegics. The most common associated injury was head trauma (15.8%), followed by limb fractures (9.5%). The incidence rate of SCI in Constanta County increased (p <0.05) and the highest increase in the incidence of spinal cord injuries was observed among patients in the age groups 29 - 49 years. Conclusions: Due to the existence of limitations, it is difficult to obtain accurate epidemiological data for SCI. Therefore, more studies are needed to provide a large amount of data and evidence. Our data indicate the need to take measures both for prevention and to provide specialized care for this type of traumatic pathology.
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Stupak, Vyacheslav Vladimirovich, and Elena Nikolayevna Rodyukova. "LOCAL LOW INTENSIVE LASER IRRADIATION FOR TREATMENT OF TROPHIC COMPLICATIONS IN PATIENTS WITH SPINAL CORD INJURIES." Hirurgiâ pozvonočnika, no. 2 (May 26, 2005): 034–40. http://dx.doi.org/10.14531/ss2005.2.34-40.
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Objective. The efficacy of low intensive laser irradiation in the treatment of decubitus and slowly granulating wounds is studied in comparison with conventional methods. Materials and Methods. Eighty two patients with trophic ulcers after spinal cord injury were conservatively treated by routine methods (35 patients) and by local laser irradiation (47 patients). The efficacy of local laser therapy was assessed basing on clinical course of healing of decubitus and slowly granulating wound, and daily epithelization rate and percentage in experimental and control groups. Results. The ulcer epithelization rate in all patients who underwent a local laser irradiation was reliably higher than in control patients. This study underlied the development of effective technique for decubitus sanation providing the increase in epithelization rate and improvement of ulcer healing.
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Johnson-Kunjukutty, Swapna, and Carmel Delille. "Impact of chronic osteomyelitis on wound healing and the quality of life of the patient with a chronic wound." WCET Journal 39, no. 2 (2019): 34–40. http://dx.doi.org/10.33235/wcet.39.2.34-40.
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Spinal cord injury (SCI) patients have a higher risk of developing pressure injury secondary to limited mobility and lack of sensation. The James J Peters Medical Center is one of several regional spinal cord injury centres in the Veterans Affairs System. Veterans with SCI receive comprehensive care. Hospital- and community-acquired pressure injuries (HAPIs and CAPIs) can progressively advance to chronic stage IV pressure injury complicated with osteomyelitis. Chronic wounds that become infected can lead to sepsis if the wounds are not managed properly. The management of chronic wounds represents a significant financial burden for any health care system and a challenge for providers whose goals are to avoid prolongation of hospital stay, avoid complications, and minimise disruption in the patient’s life. A focus of the primary physician is to establish a rehabilitation plan that facilitates the patient to resume activities of daily living post injury and have a productive life in their community. However, despite the collaborative effort of the SCI team, the sudden change in the patient’s mobility can also have a detrimental impact on the patient’s mental status as well.
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Richards, J. Scott, Samuel L. Stover, and Theresa Jaworski. "Effect of bullet removal on subsequent pain in persons with spinal cord injury secondary to gunshot wound." Journal of Neurosurgery 73, no. 3 (September 1990): 401–4. http://dx.doi.org/10.3171/jns.1990.73.3.0401.
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✓ The prevention or minimization of future pain is often cited as a reason for removal of the bullet from patients who have incurred a spinal cord injury secondary to a gunshot wound. In an attempt to examine this assumption, multimodal pain ratings were recorded for 14 patients with spinal cord injury due to a gunshot wound in whom the bullet was still present, 14 neurologically matched patients with spinal cord injury due to a gunshot wound in whom the bullet was removed, and 28 control patients with spinal cord injury unrelated to a gunshot wound who were neurologically matched to the first two groups. The results suggest that persons who sustain a spinal cord injury secondary to gunshot wounds report more pain than those injured in other ways. In addition, there was no indication that surgical removal of the bullet was helpful in reducing subsequent pain either early in the rehabilitation process or at 1 year postinjury. The location of the bullet and the type of pain that subsequently developed were not correlated with the initial decision to surgically remove the bullet. Implications for further study and clinical practice are discussed.
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Podell, Jamie E., and Nicholas A. Morris. "Traumatic Brain Injury and Traumatic Spinal Cord Injury." CONTINUUM: Lifelong Learning in Neurology 30, no. 3 (June 2024): 721–56. http://dx.doi.org/10.1212/con.0000000000001423.
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ABSTRACT OBJECTIVE This article reviews the mechanisms of primary traumatic injury to the brain and spinal cord, with an emphasis on grading severity, identifying surgical indications, anticipating complications, and managing secondary injury. LATEST DEVELOPMENTS Serum biomarkers have emerged for clinical decision making and prognosis after traumatic injury. Cortical spreading depolarization has been identified as a potentially modifiable mechanism of secondary injury after traumatic brain injury. Innovative methods to detect covert consciousness may inform prognosis and enrich future studies of coma recovery. The time-sensitive nature of spinal decompression is being elucidated. ESSENTIAL POINTS Proven management strategies for patients with severe neurotrauma in the intensive care unit include surgical decompression when appropriate, the optimization of perfusion, and the anticipation and treatment of complications. Despite validated models, predicting outcomes after traumatic brain injury remains challenging, requiring prognostic humility and a model of shared decision making with surrogate decision makers to establish care goals. Penetrating injuries, especially gunshot wounds, are often devastating and require public health and policy approaches that target prevention.
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Afshar, Ahmadreza, and Ali Tabrizi. "Razi and his Concepts on Bone and Joint Disorders." Archives of Iranian Medicine 23, no. 9 (September 1, 2020): 624–28. http://dx.doi.org/10.34172/aim.2020.74.
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This brief review presents Razi’s concepts of bone and joint disorders. Razi differentiated between ligaments, tendons, and nerves and recognized the role of the brain, spinal cord, and peripheral nervous system in the perception of senses and voluntary movements. He described paralysis and loss of sensation following brain, spinal cord, and peripheral nervous system injuries. Razi presented an early concept of compartment syndrome. Razi’s approach to fracture management is very similar to the current concept of functional bracing for some fractures. Razi mentioned suturing the wounds and ligation of bleeding large vessels. He cautioned about phlebotomy in the antecubital fossa as it may become complicated by the adjacent arterial and nerve injuries. Razi treated osteomyelitis by removing the infected and necrotic bone by sawing, cutting, and rasping. He also documented arthralgia, painful hip, and sciatic pain and made a sharp distinction between arthralgia and gout. He indicated the gout origin as the production of a waste substance that the body fails to expel. Razi’s basic concepts on the bone and joint disorders established a foundation for modern orthopedic science.
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Rathore, F. A., C. O'connell, and J. Li. "(A313) Role of Physiatrists in Post Disaster Scenarios - Lessons Learned from Pakistan, China and Haiti Earthquakes." Prehospital and Disaster Medicine 26, S1 (May 2011): s105. http://dx.doi.org/10.1017/s1049023x1100330x.
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IntroductionPhysical Medicine and Rehabilitation is a goal oriented and patient centered specialty which focuses on functional restoration and quality of life of persons with disability. The patterns of injuries among survivors of recent disasters have, range from mild (single limb fracture) to catastrophic (spinal cord injury, amputation, traumatic brain injury). Historically physiatrists have not participated the acute disaster management phase or in the emergent post disaster rehabilitation planning. This task is usually relegated to the trauma, orthopedic and general surgeons.MethodologyAuthors had firsthand experience in the acute and emergent care and rehabilitation of trauma patients after Pakistan, China and Haiti earthquakes. An electronic literature search (English, 1965–2010, Key words: trauma, rehabilitation, disability, spinal cord injury, amputation, disaster, nerve injury) was carried out. Experience sharing through committees, online forum, and communications were conducted with physiatry colleagues internationally.ResultsIn these three recent earthquakes, Physiatrists provided direct patient care, including guidance in the evacuation of survivors with pre-existing disabilities, transport of persons with spinal trauma, treatment of wounds, fractures, pain, spinal trauma patients and persons with amputations. Physiatrists devised appropriate plans for conservative management of fractures. Education of local staff and coordination of rehabilitation was initiated. Monitoring, prevention and treatment of secondary complications including prolonged immobility, pressure ulcers, chronic pain, urinary, bowel and respiratory dysfunction was performed. Physiatrists helped in patient counseling and family education.ConclusionPhysiatrists by virtue of their training and skills are in a better position to manage the disabilities, including direction of rehabilitation and community integration, prevention of complications, and education and training of health workers and teams. Timely rehabilitation interventions for Spinal cord injuries and lower limb amputations following the Pakistan, China and Haiti earthquakes resulted in reduction in morbidity and mortality among those with catastrophic injuries.
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Lobzin, S. V., and L. M. Mirzaeva. "COMPLICATIONS OF ACUTE TRAUMATIC SPINAL INJURIES IN SAINT PETERSBURG." Marine Medicine 6, no. 1 (April 9, 2020): 33–42. http://dx.doi.org/10.22328/2413-5747-2020-6-1-33-42.
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Almost every sailor during performing his job duties aboard receives injuries of varying severity, among which the most common are deck fractures, including compression vertebral fractures, as well as open and closed vertebral fractures with spinal cord injuries. Besides the recovery of disordered functions of the spinal cord, in cases of spinal cord injury, the fight against numerous neurological, infectious and somatic complications affecting the survival and quality of life of patients is still relevant.Objective: to study the incidence of complications of traumatic injuries of the spinal cord under initial hospitalization, their impact on the length of hospital stay, to identify and evaluate the role of risk factors in the development of complications.Materials and methods. A retrospective cohort study was conducted according to the archived case histories of patients hospitalized in neurosurgical hospitals in St. Petersburg. 311 cases of acute spinal cord injury in 2012–2016 were analyzed.Results: complications not directly related to spinal cord injury, such as bronchitis, pneumonia, bedsores, sepsis, thromboembolism, urinary tract infections, postoperative wound pyogenesis and others (damage to other organs and systems), were found in one third of patients (33,8%), in half of the cases there were multiple complications (2 or more), the most frequent — respiratory (23,5%) and pressure sores (10%). Complications significantly increased the length of hospital stay. The dependence of the frequency of complications on age, the level of spinal cord damage and the severity of the injury was revealed. Risk factors such as concomitant head injury and alcohol intoxication have been found. The revealed positive effect of corticosteroids on the regression of neurological deficit was not statistically confirmed. At the same time, there was a significant increase in the frequency of respiratory complications when using corticosteroids.Conclusion: Knowledge of the factors affecting the incidence of complications, optimization of their prevention and therapy will shorten the duration of hospitalization and improve the prognosis and quality of life of patients. The issue of use of corticosteroid therapy in the acute period of traumatic injuries of the spinal cord remains debatable. When choosing therapeutic tactics for managing patients with spinal trauma, it is necessary to take into account the risk of respiratory complications and carefully evaluate the ratio of benefits to harm.
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Bellucci, Carlos Henrique Suzuki, Jose Everton de Castro Filho, Cristiano Mendes Gomes, José de Bessa Jr., Linamara Rizzo Battistella, Daniel Rubio de Souza, Márcia Scazufca, Homero Bruschini, Miguel Srougi, and Tarcisio E. P. Barros Filho. "Contemporary Trends in the Epidemiology of Traumatic Spinal Cord Injury: Changes in Age and Etiology." Neuroepidemiology 44, no. 2 (2015): 85–90. http://dx.doi.org/10.1159/000371519.
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Background: Epidemiological features of spinal cord injury (SCI) have been changing over the last decades. We evaluated the contemporary trends in the epidemiology of traumatic SCI patients from a rehabilitation center. Methods: In a cross-sectional study, a consecutive series of 348 patients with traumatic SCI were evaluated. Variables were collected through an epidemiological form, which included gender, age at injury, duration and cause of SCI. We investigated SCI epidemiological trends over time including the association between gender and age at injury with SCI features such as etiology, injury severity and level. Results: The mean age at SCI has increased from 26.0 ± 11.8 in patients with SCI before 2003 to 37.9 ± 15.7 in those with SCI after 2009 (p < 0.001). Gunshot wounds were the main cause of injury in patients with SCI before 2003, dropping from 40.6 to 16.9% after 2009 and being surpassed by road traffic injuries (38.6%) and falls (31.4%) after 2009 (p < 0.001). Gender, SCI severity and level have not changed significantly over the time. Conclusions: There was a major increase in the average age of patients as well as changes in the etiology of SCI over the past fifteen years, including a significant decrease in gunshot wounds and an increase in the frequency of road traffic injuries and falls. These changes and accompanying risk factors must be taken into consideration when planning measures to prevent SCI.
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Carrillo, Eddy H., Janice K. Gonzalez, Lilian E. Carrillo, Patricia M. Chacon, Nicholas Namias, Orlando C. Kirton, and Patricia M. Byers. "Spinal cord injuries in adolescents after gunshot wounds: an increasing phenomenon in urban North America." Injury 29, no. 7 (September 1998): 503–7. http://dx.doi.org/10.1016/s0020-1383(98)00110-7.
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Dowdy, Justin, and T. Glenn Pait. "The influence of war on the development of neurosurgery." Journal of Neurosurgery 120, no. 1 (January 2014): 237–43. http://dx.doi.org/10.3171/2013.8.jns122369.
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The treatment of craniospinal war wounds proved to be a significant driving force in the early growth of neurosurgery as a specialty. This publication explores the historical relationship between the evolution of combat methodology from antiquity through modern conflicts as it dovetails with and drives corresponding advancements in the field of neurosurgery. Whether it's the basic management principles for intracranial projectile wounds derived from World War I experiences, the drastic improvement in the outcomes and management of spinal cord injuries observed in World War II, or the fact that both of these wars played a crucial role in the development of a training system that is the origin of modern residency programs, the influence of wartime experiences is pervasive.
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Šulla, Igor, Slavomír Horňák, and Štefánia Papcúnová. "Topical Application of Hypothermia in a Porcine Spinal Cord Injury Model." Folia Veterinaria 67, no. 3 (September 1, 2023): 57–64. http://dx.doi.org/10.2478/fv-2023-0028.
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Abstract Spinal cord injuries (SCIs) are catastrophic events in humans and animals. They often result in permanent loss of motor, sensory, and autonomic functions caudally from the site of the spinal cord (SC) lesion. The natural history of spontaneous recovery from SC trauma is disappointing and currently available therapeutic interventions fail to operate. Hence further research using bigger experimental animals or primates is necessary. The results of this study performed by the authors in 21 Göttingen-Minnesota-Liběchov female minipigs (3 sham controls, and 18 members of an experimental subgroup) showed that these animals are suitable for SCI research. All mini-pigs survived rather complex experiments carried out in general anaesthesia induced by 5 % thiopental solution administered i.v., maintained by endotracheal inhalation of 1.5 % sevoflurane with O2 as well as a subsequent 9-week monitoring period. The experimental procedures comprised of L3 laminectomy, SCI inflicted by computer-controlled metallic piston crushing the SC with 8N, 15N, or 18N force. After the SCIs there were 9 minipigs left over during the next 5.5 hours in general anaesthesia, without application of hypothermia, then the surgical wounds were sutured, and the animals were allowed to awaken under supervision. Just 30 min following SCIs was in 6 mini-pigs started with the 5-hour application of 4 °C saline via perfusion chambers placed at the epicenter of the SCI, the chambers were removed, surgical wounds sutured, and animals were allowed to awaken. Just 30 minutes following the SCIs, there was in 3 minipigs started with a 5-hour administration of ≈24 °C saline at the epicentre of the SCIs, and then the perfusion chamber was removed, surgical wounds sutured, and the animals were allowed to awaken. The 5.5-hour local hypothermia and protracted general anaesthesia required monitoring of rectal temperature, and external warming of the minipig, if the temperature dropped below 36 °C. The currently available information on the therapeutic capacity of the method, and all technical aspects of its routine employment, needs validation in further experiments and preclinical trials.
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Kumar, Anand, Umesh Kumar Meena, Ram Prasad Meena, and Ekaansh Karir. "One year old misdiagnosed penetrating injury of sacrum with a retained knife: a case report and review of literature." International Journal of Research in Orthopaedics 10, no. 3 (April 29, 2024): 693–96. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20241125.
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Penetrating injuries to the spine, although less common than blunt trauma from motor vehicle accidents, are important causes of injury to the spinal cord. They are essentially of two varieties-gunshot or stab wounds. Gunshot injuries to the spine are more commonly described and are associated with a higher incidence of neurological damage. On the contrary, the prognosis is better in stab wounds where surgery plays a greater role. Here we report a case of a 31 year old male with a history of penetrating injury with knife in lower back 1 year ago comes with complaints of pain and pus discharge since 2 weeks. On detailed history taking, clinical examination and investigations it was found that knife was left in situ which was causing symptoms. Surgical exploration was done. Foreign body (knife) was removed keeping all the neurovascular complications in check. Post operatively patient is doing good with no neurological deficits. A timely intervention in removing foreign body is necessary for preventing for complications.
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PERVEEN, A., S. ABBAS, SU KHAN, M. MAZHAR, and A. FIAZ. "EVALUATION OF THERAPEUTIC EFFICACY OF ALOE VERA GEL FOR EXCISIONAL WOUND HEALING MECHANISM USING ANIMAL MODEL." Biological and Clinical Sciences Research Journal 2023, no. 1 (June 23, 2023): 340. http://dx.doi.org/10.54112/bcsrj.v2023i1.340.
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Wound-healing diseases are considered significant clinical issues in patients, which become more complicated in association with obesity, diabetes mellitus, and high blood pressure conditions. Various therapeutic options were available for the wound-repairing process. The current study project evaluated the healing properties of Aloe Vera gel on epidermal wounds in rats. Experimental animals (adult rats) were divided into groups A, B, and C with equal distribution. These groups represent treatment, without treatment, and control, respectively. A pair of wounds measuring 2cm x 2cm each was created hygienically on the back of each rat lateral to the spinal cord. The wounds were treated with homogenized Aloe Vera gel, while the injuries in the second group were treated with normal saline. Blood samples were collected on days 21 for hematology analysis with a standard method. Animals in group ‘A’ had significantly faster healing with shorter days of skin fall-off than the control and untreated group. Further biochemical changes in the packed cell volume, mean corpuscular volume, lymphocyte and neutrophil counts also showed significant results compared to the control group. The study concluded that Aloe Vera effectively treated epidermal wounds in adult rat models. An improvement occurred in the hematological profile of the experimental animals. These findings will go a long way in expanding the horizon of the clinical application of this plant in solving wound-healing problems in humans and other animal species.
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Hanigan, William C., and Chris Sloffer. "Nelson's wound: treatment of spinal cord injury in 19th and early 20th century military conflicts." Neurosurgical Focus 16, no. 1 (January 2004): 1–13. http://dx.doi.org/10.3171/foc.2004.16.1.5.
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During the first half of the 19th century, warfare did not provide a background for a systematic analysis of spinal cord injury (SCI). Medical officers participating in the Peninsular and Crimean Wars emphasized the dismal prognosis of this injury, although authors of sketchy civil reports persuaded a few surgeons to operate on closed fractures. The American Medical and Surgical History of the War of the Rebellion was the first text to provide summary of results in 642 cases of gunshot wounds of the spine. The low incidence of this injury (0.26%) and the high mortality rate (55%) discouraged the use of surgery in these cases. Improvements in diagnoses and the introduction of x-ray studies in the latter half of the century enabled Sir G. H. Makins, during the Boer War, to recommend delayed intervention to remove bone or bullet fragments in incomplete injuries. The civil experiences of Elsberg and Frazier in the early 20th century promoted a meticulous approach to treatments, whereas efficient transport of injured soldiers during World War I increased the numbers of survivors. Open large wounds or cerebrospinal fluid leakage, signs of cord compression in recovering patients, delayed clinical deterioration, or intractable pain required surgical exploration. Wartime recommendations for urological and skin care prevented sepsis, and burgeoning pension systems provided specialized long-term rehabilitation. By the Armistice, the effective surgical treatment and postoperative care that had developed through decades of interaction between civil and military medicine helped reduce incidences of morbidity and dispel the hopelessness surrounding the combatant with an SCI.
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El Hajj Abdallah, Yasmeen, Julie Beveridge, Ming Chan, Taha Deeb, Hani Mowafi, Saleem Al-Nuaimi, Abdulkader Saed Easa, and Maher Saqqur. "Devastating neurologic injuries in the Syrian war." Neurology: Clinical Practice 9, no. 1 (December 6, 2018): 9–15. http://dx.doi.org/10.1212/cpj.0000000000000556.
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BackgroundSince 2011, hundreds of thousands of Syrians have been displaced and injured due to the ongoing Syrian civil war. In this study, we report the prevalence of neurologic injuries in a major rehabilitation center on the Turkish–Syrian border where death and injury tolls continue to rise.MethodBased on several on-site visits from 2013 to 2016, medical practitioners collected data from patients in the major rehabilitation center on the border of Turkey and Syria. The clinical data, which included the type and cause of injury, laterality, paralysis, areas injured, and treatment offered, were analyzed.ResultsA total of 230 patients were identified as having sustained a neurologic injury, 221/230 (96.1%) male and 9/230 (3.91%) female, ranging from ages 2–52 years. A total of 305 total injuries were documented over the course of a 4-year analysis due to several patients having multiple injuries. Gunshot wounds were the dominant mechanism of injury in 125/230 (54.3%) patients. Patients more frequently sustained single injuries 152/230 (66.1%) than multiple injuries 78/230 (33.9%). Peripheral nerve injuries were the most prevalent injuries, at 92.5% of all neurologic injuries (282/305), specifically injury to the radial nerve, at 19.1% (54/282) of peripheral injuries. Patients with spinal cord injuries made up 20/230 (8.7%) of all patients, with thoracic spine injuries composing 50% (10/20). Traumatic brain injuries were the least prevalent, 3/230 (1.3%), with an equal distribution of subtypes.ConclusionThis study and critical analysis of the devastation in Syria suggests the desperate need for emergency aid.
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Rosin, Nicole R., Robyn S. Tabibi, John D. Trimbath, and Mary Kristina Henzel. "A Primary Care Provider’s Guide to Prevention and Management of Pressure Injury and Skin Breakdown in People With Spinal Cord Injury." Topics in Spinal Cord Injury Rehabilitation 26, no. 3 (October 2020): 177–85. http://dx.doi.org/10.46292/sci2603-177.
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Skin breakdown, including burns and pressure injuries (PrIs), is a devastating complication of spinal cord injury (SCI). Chronic wounds place the person with SCI at high risk of infections, sepsis, and death. Skin health and breakdown is individual and multifactorial, thus prevention requires individualized education focused on patient preferences and goals. Assessment requires an accurate description of wound type/PrI stage, location, size, wound bed, wound margin, epithelialization, exudate, and peri-wound condition. PrIs should be staged using the National Pressure Injury Advisory Panel (NPIAP) staging system. Successful treatment requires optimal wound bed preparation, pressure off-loading, and access to surgical specialists if needed. Mattress and seating systems, pressure relief, skin microclimate, nutrition, and home supports should be optimized. To promote wound healing and aid prevention, identifiable causes need to be removed, risk factors improved, and wound care provided. Infection should be treated with input from infectious disease specialists. Consideration for specialized surgical management including flaps and primary closures should be coordinated with the interdisciplinary team to optimize outcomes. If comorbid conditions promote wound chronicity, a palliative rather than curative treatment plan may be needed.
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Lehre, Martin Andreas, Lars Magnus Eriksen, Abenezer Tirsit, Segni Bekele, Saba Petros, Kee B. Park, Marianne Lundervik Bøthun, and Knut Wester. "Outcome in patients undergoing surgery for spinal injury in an Ethiopian hospital." Journal of Neurosurgery: Spine 23, no. 6 (December 2015): 772–79. http://dx.doi.org/10.3171/2015.3.spine141282.
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OBJECT The objective of this study was to investigate epidemiology and outcome after surgical treatment for spinal injuries in Ethiopia. METHODS Medical records of patients who underwent surgery for spine injuries at Myungsung Christian Medical Center in Addis Ababa, Ethiopia, between January 2008 and September 2012 were reviewed retrospectively. Assessment of outcome and complications was determined from patient consultations and phone interviews. RESULTS A total of 146 patients were included (129 males, 17 females). Their mean age was 31.7 years (range 15–81 years). The leading cause of injury was motor vehicle accidents (54.1%), and this was followed by falls (26.7%). The most common injury sites were lumbar (41.1%) and cervical (34.2%) regions of the spine. In 21.2% of patients, no neurological deficit was present before surgery, 46.6% had incomplete spinal cord injury (American Spinal Injury Association [ASIA] Impairment Scale [AIS] Grade B-D), and 32.2% had complete spinal cord injury (AIS Grade A). Follow-up was hampered by suboptimal infrastructure, but information regarding outcome was successfully obtained for 110 patients (75.3%). At follow-up (mean 22.9 months; range 2–57 months), 25 patients (17.1%) were confirmed dead and 85 patients (58.2%) were alive; 49 patients (33.6%) underwent physical examination. At least 8 of the 47 patients (17.0%) with a complete injury and 29 of the 68 patients (42.6%) with an incomplete injury showed neurological improvement. The reported incidences of pressure wounds, recurrent urinary tract infections, pneumonia, and thromboembolic events were 22.5%, 13.5%, 5.6%, and 1.1%, respectively. CONCLUSIONS Patients showed surprisingly good recovery considering the limited resources. Surgical treatment for spine injuries in Ethiopia is considered beneficial.
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Vall, Janaína, Carlos Mauricio de Castro Costa, Terezinha de Jesus Teixeira Santos, and Samuel Bovy de Castro Costa. "Neuropathic pain characteristics in patients from Curitiba (Brazil) with spinal cord injury." Arquivos de Neuro-Psiquiatria 69, no. 1 (February 2011): 64–68. http://dx.doi.org/10.1590/s0004-282x2011000100013.
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This was a descriptive cross-sectional study on patients with spinal cord injuries living in Curitiba, Paraná, Brazil. The aim was to evaluate the pain characteristics among such patients seen at referral care centers for spinal cord injury patients in Curitiba. A total of 109 adults with spinal cord injury in this city were evaluated regarding the presence of pain, especially neuropathic pain. Neuropathic pain was evaluated using the DN4 questionnaire, a universal instrument that has been translated and validated for Portuguese. A visual analog scale (VAS) was used to evaluate the intensity of pain. The prevalence of pain among these 109 patients was 31.2% (34 patients). The nociceptive pain presented was classified as musculoskeletal pain (nine patients), visceral pain (four patients) and mixed pain (one patient), thus totaling 14 patients (12.8%). Another 20 patients (18.3%) showed symptoms of neuropathic pain and fulfilled the criteria for neuropathic pain with scores greater than 4 out 10 in the DN4 questionnaire. Regarding the characteristics of the patients with neuropathic pain, most of them were male, younger than 40 years of age and paraplegic with incomplete lesions. They had become injured from 1 to more than 5 years earlier. The predominant etiology was gunshot wounds, and the intensity of their pain was high, with VAS scores greater than 5. This study partially corroborates other studies conducted on this subject. Studies of this type are important for understanding the profile of these patients, for the purpose of designing strategies for their rehabilitation, with a focus on the appropriate treatment and management of pain.
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Kim, Myeong Ok. "Prevention and treatment of pressure sore following spinal cord injury." Journal of the Korean Medical Association 63, no. 10 (October 10, 2020): 623–32. http://dx.doi.org/10.5124/jkma.2020.63.10.623.
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Pressure sores or pressure injury is a serious complication of a spinal cord injury (SCI), representing a challenging problem for patients, their caregivers, and their physicians. Persons with SCI are vulnerable to pressure sores throughout their life. Pressure sores can potentially interfere with the physical, psychosocial, and overall quality of life. Outcomes directly depend on education and prevention along with conservative and surgical management. Therefore, it is very important to understand everything about pressure sores following SCI. This review covers epidemiology, cost, pathophysiology, risk factors, staging, evaluation tools, prevention, education, conservative wound care methods, surgical treatment, and future trends in wound healing related to post-SCI pressure sores. A change in nomenclature was adopted by the National Pressure Ulcer Advisory Panel in 2016, replacing “pressure ulcer”with “pressure injury.” New concepts of pressure injury staging, such as suspected deep tissue injuries and unstageable pressure injuries, were also introduced. A systematic evidence-based review of the prevention of and therapeutic interventions for pressure sores was also discussed.
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Pizetta, Guilherme Rohden, Carlos Henrique Maçaneiro, Rodrigo Fetter Lauffer, Ricardo Kiyoshi Miyamoto, Ana Paula Bonilauri Ferreira, and Ricardo André Acácio dos Santos. "EPIDEMIOLOGICAL ANALYSIS OF SPINAL CORD INJURY IN THE CITY OF JOINVILLE (SC)." Coluna/Columna 19, no. 1 (March 2020): 48–51. http://dx.doi.org/10.1590/s1808-185120201901223272.
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ABSTRACT Objective This paper proposes a retrospective analysis of the spinal cord trauma at a regional hospital that is a Unified Health System (SUS) reference in Orthopedics and Traumatology, considering epidemiological data and comparing treatments and hospitalization costs. Methods This study is a retrospective, analytical-descriptive, exploratory documental analysis, using data from the medical records of patients treated for spinal cord trauma during 2016 at the São José Municipal Hospital (Joinville, SC). Results Twenty-three patients were included in the study, 20 of whom (87%) were male. As to etiology, traffic accidents accounted for 47.8% of the cases and gunshot wounds were in second place with 26.1% of the injuries. The correlation between the cost of hospitalization and the days of hospitalization was statistically significant (p = 0.013), as was the correlation between the cost of hospitalization and the number of procedures (p = 0.000). Conclusions Surgical treatment demands greater amounts of financial and human resources. The purpose of this study is to provide local epidemiological data to encourage discussion about other studies, as well as planning for resource allocation and public policy. Level of evidence II; Retrospective Study.
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Beaty, Narlin, Justin Slavin, Cara Diaz, Kyle Zeleznick, David Ibrahimi, and Charles A. Sansur. "Cervical spine injury from gunshot wounds." Journal of Neurosurgery: Spine 21, no. 3 (September 2014): 442–49. http://dx.doi.org/10.3171/2014.5.spine13522.
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Object Gunshot wounds (GSWs) to the cervical spine have been examined in a limited number of case series, and operative management of this traumatic disease has been sparsely discussed. The current literature supports and the authors hypothesize that patients without neurological deficit need neither surgical fusion nor decompression. Patients with GSWs and neurological deficits, however, pose a greater management challenge. The authors have compiled the experience of the R Adams Cowley Shock Trauma Center in Baltimore, Maryland, over the past 12 years, creating the largest series of such injuries, with a total number of 40 civilian patients needing neurosurgical evaluation. The current analysis examines presenting bone injury, surgical indication, presenting neurological examination, and neurological outcome. In this study, the authors characterize the incidence, severity, and recovery potential of cervical GSWs. The rate of unstable fractures requiring surgical intervention is documented. A detailed discussion of surgical indications with a treatment algorithm for cervical instability is offered. Methods A total of 144 cervical GSWs were retrospectively reviewed. Of these injuries, 40 had documented neurological deficits. No neurosurgical consultation was requested for patients without deficit. Epidemiological and clinical information was collected on patients with neurological deficit, including age, sex, timing, indication, type of surgery, initial examination after resuscitation, follow-up examination, and imaging data. Results Twenty-eight patients (70%) presented with complete neurological deficits and 12 patients (30%) presented with incomplete injuries. Fourteen (35%) of the 40 patients underwent neurosurgical intervention. Twelve patients (30%) required intervention for cervical instability. Seven patients required internal fixation involving 4 anterior fusions, 2 posterior fusions, and 1 combined approach. Five patients were managed with halo immobilization. Two patients underwent decompression alone for neurological deterioration and persistent compressive injury, both of whom experienced marked neurological recovery. Follow-up was obtained in 92% of cases. Three patients undergoing stabilization converted at least 1 American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade and the remaining operative cases experienced small ASIA motor score improvement. Eighteen patients underwent inpatient MRI. No patient suffered complications or neurological deterioration related to retained metal. Three of 28 patients presenting with AIS Grade A improved to Grade B. For those 12 patients with incomplete injury, 1 improved from AIS Grade C to D, and 3 improved from Grade D to E. Conclusions Spinal cord injury from GSWs often results in severe neurological deficits. In this series, 30% of these patients with deficits required intervention for instability. This is the first series that thoroughly documents AIS improvement in this patient population. Adherence to the proposed treatment algorithm may optimize neurological outcome and spine stability.
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Mackowsky, Matthew, Nicole Hadjiloucas, Stuart Campbell, and Constantine Bulauitan. "Penetrating spinal cord injury: A case report and literature review." Surgical Neurology International 10 (July 26, 2019): 146. http://dx.doi.org/10.25259/sni_221_2019.
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Background: Penetrating spinal cord injury (pSCI) is uncommon in civilian settings. However, there is a lack of consensus regarding perioperative management and thresholds for operative intervention. This review explores the various trends in the management of pSCI along with a literature review. Case Description: A 34-year-old male presented with a gunshot wound (GSW) to the left chest. Injuries included a pneumothorax, diaphragmatic injury, splenic injury, multiple small bowel injuries, transverse colon injury, and a bullet lodged at the L5 spinal level. The patient underwent chest tube placement, an exploratory laparotomy, splenectomy, diaphragmatic repair, multiple small bowel resections, and a transverse colon resection. Later on, the patient required a lumbar laminectomy for wound debridement and bullet excision. Conclusion: The standards for the surgical management of pSCI are poorly defined. Older studies suggested that >7 days of antibiotics decreased the risk of infection associated with HVI while shorter regimens correlated with higher rates of spinal and neurologic infections (meningitis, paraspinal abscess, and osteomyelitis). Newer studies fail to confirm the benefit of extended antimicrobial therapy, noting no increased infections with 48 h or less of antibiotic use while suggesting increased risks of long-term antibiotic prophylaxis (i.e., antimicrobial resistance and Clostridium difficile infection). There is no current role for steroids in the treatment of pSCI, and routine operative management is no longer necessarily indicated.
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Crowley, R. Webster, Ricky Medel, and Aaron S. Dumont. "Traumatic high flow vertebral-venous fistula presenting with delayed ischemic stroke: endovascular management with detachable coils and Amplatzer Vascular Plugs." Neurosurgical Focus 26, no. 3 (March 2009): E5. http://dx.doi.org/10.3171/2008.12.focus08274.
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Penetrating injuries to the neck can result in a number of abnormalities that are of interest to neurosurgeons and interventional neuroradiologists. Gunshot or stab wounds may cause damage to the cervical spinal cord, the adjacent osseous and ligamentous structures, and the peripheral or cranial nerves. In addition, a significant percentage of penetrating wounds to this location result in vascular injury. These may present insidiously or acutely and with a variety of symptoms. The authors present the case of a patient in whom an occipital lobe infarction developed roughly 2 months after the patient was struck in the neck by a bullet. He was found to have a complete transection of the left vertebral artery, with an associated vertebral-venous fistula. The fistula was eventually treated endovascularly with a combination of platinum coils and Amplatzer Vascular Plugs. The management is discussed, with specific emphasis on the technical aspects of the case.
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Miller, Joseph H., Holly A. Zywicke, James B. Fleming, Christoph J. Griessenauer, Thomas R. Whisenhunt, Mamerhi O. Okor, Mark R. Harrigan, Patrick R. Pritchard, and Mark N. Hadley. "Neurosurgical injuries resulting from the 2011 tornados in Alabama: the experience at the University of Alabama at Birmingham Medical Center." Journal of Neurosurgery 118, no. 6 (June 2013): 1356–62. http://dx.doi.org/10.3171/2013.3.jns121656.
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Object The April 27, 2011, tornados that affected the southeastern US resulted in 248 deaths in the state of Alabama. The University of Alabama at Birmingham (UAB) Medical Center, the largest Level I trauma center in the state, triaged and treated a large number of individuals who suffered traumatic injuries during these events, including those requiring neurosurgical assessment and treatment. Methods A retrospective review of all adult patients triaged at UAB Medical Center during the April 27, 2011, tornados was conducted. Those patients who were diagnosed with and treated for neurosurgical injuries were included in this cohort. Results The Division of Neurosurgery at UAB Medical Center received 37 consultations in the 36 hours following the tornado disaster. An additional patient presented 6 days later, having suffered a lumbar spine fracture that ultimately required operative intervention. Twenty-seven patients (73%) suffered injuries as a direct result of the tornados. Twenty-three (85%) of these 27 patients experienced spine and spinal cord injuries. Four patients (15%) suffered intracranial injuries and 2 patients (7%) suffered combined intracranial and spinal injuries. The spinal fractures that were evaluated and treated were predominantly thoracic (43.5%) and lumbar (43.5%). The neurosurgery service performed 14 spinal fusions, 1 ventriculostomy, 2 halo placements, 1 diagnostic angiogram, 1 endovascular embolectomy, and 1 wound debridement and lavage. Twenty-two patients (81.5%) were neurologically intact at discharge and all but 4 had 1 year of follow-up. Three patients had persistent deficits from spinal cord injuries and there was 1 death in a patient with multisystem injuries in whom no procedures were performed. Two patients experienced postoperative complications in the form of 1 wound infection and 1 stroke. Conclusions The April 27, 2011, tornados in Alabama produced significant neurosurgical injuries that primarily involved the spine. There were a disproportionate number of patients with thoracolumbar fractures, a finding possibly due to the county medical examiner's postmortem findings that demonstrated a high prevalence of fatal cervical spine and traumatic brain injuries. The UAB experience can be used to aid other institutions in preparing for the appropriate allotment of resources in the event of a similar natural disaster.
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Muya, Christine, Julie Phillips, Joseph Matheri, and Sore Bilton. "Prevalence of Individuals with Traumatic Spinal Cord Injury in Nairobi, Kenya." International Journal of Physiotherapy and Research 11, no. 5 (October 11, 2023): 4622–27. http://dx.doi.org/10.16965/ijpr.2023.151.
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Objectives: To determine the prevalence of individuals with a traumatic spinal cord injury in Nairobi, Kenya. Methods: Retrospective quantitative data was extracted from records of 1st January 2010 to December 2014, at the NSIH. (N=320) participants met the inclusion criteria of all TSCI patients injured archived medical files, out these (n=217) were men, and (n=103) women, collected data was analyzed by SPSS version 23.0. Pearson chi-square was applied to test for association between variables, Student t-test was used to compare mean difference between groups, study Significance level was at p-value <0.05. Results: Mean age of the participants was 37.59 (SD= 15.038), the highest percentage age was 30-39 years old at (27.8%) followed aged 18-29 years at (26.6%). Male to female ratio was 2.1:1, highest prevalence occurred in 2010 and 2014 (20.5%), main cause of a TSCI transportation (49.1%), fall at (33.4%), assault (17.5%) common injury location was at lumber (53.1%), followed thoracic at (27.5%) cervical and sacral at (19.1%) and (0.3%) respectively. There were significantly more persons with paraplegia (54.1%) who had complete injuries than those with tetraplegia (19.6%). Other (27.3%) accounted for the TSCI patients with incomplete paraplegia and tetraplegia and no neurological deficits Conclusions: TSCI is a devastating condition to individuals; it has a high impact on QOL and ADL in low-income countries where there is an increase in manual labor and poor infrastructure, which predispose individuals to TSCI. Further studies need to be done to understand and compare epidemiological results, to inform appropriate prevention strategies that will decrease the burden of TSCI globally. KEYWORDS: Traumatic Spinal Cord Injuries, Activities of Daily Living, Gun Short Wound, National Spinal Injury Hospital, American Spinal Injury Association impairment scale.
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Metke, Ricardo, Andrea Araujo, Julian Chavarriaga, Catalina Villaquiran, Juan Guillermo Cataño, Maddy Mejía, Sergio Cervera Bonilla, Julián Chavarriaga, and Laura Castillo. "Squamous cell carcinoma arising from suprapubic cystostomy: report of two cases and a narrative review of literature." International Surgery Journal 9, no. 5 (April 26, 2022): 1074. http://dx.doi.org/10.18203/2349-2902.isj20221158.
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Squamous cell carcinoma arising from Marjolin’s ulcer of the suprapubic cystostomy tract is a rare entity that usually occurs in patients with a history of spinal cord injuries and a chronic indwelling catheter. We present 2 cases of this rare entity with the clinical exams needed for diagnosis and treatment according to individual characteristics of each case. Marjolin’s ulcer is a cutaneous malignancy that arises from injured skin. The most frequent type of malignancy identified on histopathologic examination is squamous cell carcinoma (80-90%). It can develop from long-standing scars, chronic wounds, pressure ulcers, osteomyelitis, and burns. Only cases have been reported about Marjolin’s ulcer with squamous cell carcinoma at the cystostomy cite. Treatment regimens have not been standardized; cases have received individualized treatments, usually with excision, radiation, or a combination of both. There is insufficient evidence to aid in the understanding of the etiology. In addition, there is no consensus on its optimal treatment and follow-up schemes.
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Metke, Ricardo, Andrea Araujo, Julian Chavarriaga, Catalina Villaquiran, Juan Guillermo Cataño, Maddy Mejía, Sergio Cervera Bonilla, Julián Chavarriaga, and Laura Castillo. "Squamous cell carcinoma arising from suprapubic cystostomy: report of two cases and a narrative review of literature." International Surgery Journal 9, no. 5 (April 26, 2022): 1074. http://dx.doi.org/10.18203/2349-2902.isj20221158.
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Squamous cell carcinoma arising from Marjolin’s ulcer of the suprapubic cystostomy tract is a rare entity that usually occurs in patients with a history of spinal cord injuries and a chronic indwelling catheter. We present 2 cases of this rare entity with the clinical exams needed for diagnosis and treatment according to individual characteristics of each case. Marjolin’s ulcer is a cutaneous malignancy that arises from injured skin. The most frequent type of malignancy identified on histopathologic examination is squamous cell carcinoma (80-90%). It can develop from long-standing scars, chronic wounds, pressure ulcers, osteomyelitis, and burns. Only cases have been reported about Marjolin’s ulcer with squamous cell carcinoma at the cystostomy cite. Treatment regimens have not been standardized; cases have received individualized treatments, usually with excision, radiation, or a combination of both. There is insufficient evidence to aid in the understanding of the etiology. In addition, there is no consensus on its optimal treatment and follow-up schemes.