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The goal of this study was to assess the therapeutic potential of a 5-hour local spinal cord (SC) hypothermia by 4 °C saline on preservation of SC tissue at the injury epicentre and 3 cranial and caudal 10 mm long SC segments in a porcine experimental model of spinal cord injury (SCI). The SCI was inflicted through L3 laminectomy by a metallic rod moved by a velocity of 30 mm.sec−1, and operated by a computer-controlled apparatus. A group of 15 female minipigs 5‒8-month-old weighing 28‒35 kg was randomly divided into 5 subgroups (each composed of 3 animals): 1) sham controls; 2) SCI by force 8N; 3) SCI by force 8N, 5-hour hypothermia; 4) SCI by force 15N; 5) SCI by force 15N, 5-hour hypothermia. After a 9-week survival period, the minipigs were in deep general anaesthesia transcardially perfused by 5000 ml of saline and fixed by 5000 ml 4 % neutral paraformaldehyde. White and grey SC matter damage was evaluated in specimens cut from the epicentre of injury as well as 3 cranial and 3 caudal 10 mm long SC blocks dyed according to Luxol fast blue (LFB) with cresyl violet (CV) protocol for light microscopic observations. The percentage of preserved SC white and grey matter was assessed in microphotographs and compared with data from sham controls (considered 100 %). The data were statistically evaluated by ANOVA test, the difference P ˂ 0.05 was considered significant. Results of the study suggest that 5-hour local cooling of the epicentre of SCI is well tolerated and facilitates the preservation of SC tissue integrity. Additional experimental and preclinical studies are necessary before introducing the method in practice. [ABSTRACT FROM AUTHOR]

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Both anterior and posterior approaches have shown insignificant differences in good clinical outcomes with one over another advantages and disadvantages. This review aimed to provide evidence for the best management of subaxial cervical spine injuries and discuss the clinical outcomes and complications. Clinical studies of anterior versus posterior and anterior versus anterior–posterior (combined) approaches to subaxial cervical spine injury were searched electronically from PubMed, Medline, ScienceDirect, Cochrane Library, and other Internet databases. Clinical improvement, complication rates, and mortality rates showed no significant differences with an odds ratio of 1.09 (95% confidence interval [CI], 0.79–1.49; p=0.61) for the anterior versus posterior approach and an odds ratio of 1.05 (95% CI, 0.35–3.18; p=0.93) for the anterior versus the combined approach. Surgical duration and blood loss were significantly different between the anterior and posterior groups with a mean difference of −42.84 (95% CI, −64.39 to 21.29; p<0.0001); −212.91 (95% CI, −417.60 to 8.22; p=0.04), respectively, whereas the length of hospitalization did not (p=0.16). No difference was found between the groups when compared by clinical improvement and complication rate. Meanwhile, the anterior approach was superior to the posterior approach in terms of surgical duration, blood loss, and hospitalization length. [ABSTRACT FROM AUTHOR]

Both anterior and posterior approaches have shown insignificant differences in good clinical outcomes with one over another advantages and disadvantages. This review aimed to provide evidence for the best management of subaxial cervical spine injuries and discuss the clinical outcomes and complications. Clinical studies of anterior versus posterior and anterior versus anterior–posterior (combined) approaches to subaxial cervical spine injury were searched electronically from PubMed, Medline, ScienceDirect, Cochrane Library, and other Internet databases. Clinical improvement, complication rates, and mortality rates showed no significant differences with an odds ratio of 1.09 (95% confidence interval [CI], 0.79–1.49; p=0.61) for the anterior versus posterior approach and an odds ratio of 1.05 (95% CI, 0.35–3.18; p=0.93) for the anterior versus the combined approach. Surgical duration and blood loss were significantly different between the anterior and posterior groups with a mean difference of −42.84 (95% CI, −64.39 to 21.29; p

Neurogenic bowel management in persons with spinal cord injury (SCI) is an important issue due to the associated morbidities causing a significant impact on the persons’ quality of life (QOL) and burden the caregiver and healthcare services. Complications such as constipation, diarrhoea, incontinence, social embarrassment and autonomic dysreflexia can be managed effectively and resourcefully to counter the ill effects. In India, the incidence of SCI is 15,000, with a prevalence of 0.15 million; most are educationally and economically underprivileged with substandard living conditions. Complications associated with neurogenic bowel tend to impede the implementation of vocational rehabilitation and community integration measures. The goals of management are to prevent complications and improve the QOL of persons with SCI. With the revolutionary progress in medical science, many pharmacological, non-pharmacological and surgical options have been formulated to satisfactorily and effectively manage the neurogenic bowel. In this narrative review, we have tried to compile some of the most popular and time-tested options for managing neurogenic bowel in persons with SCI.

Objectives: This study was conducted to investigate the factors affecting mortality due to spinal cord traumain patients admitted to the intensive care unit (ICU).Methods: This study was conducted in a group of patients who were admitted to the ICU with a TraumaticSpinal Injuries (TSI) diagnosis. The researcher started sampling by assessing the documents of the patientshospitalized in the ICU, and the diagnosis of TSI was confirmed for them. Besides, utilizing a researcher-madechecklist, factors affecting the mortality of patients were identified. The data were analyzed using the SPSSsoftware version 16. P

Ultrasound evaluation of diaphragm function allows the detection of diaphragm dysfunction and the adaptation of ventilatory support in patients admitted to intensive care units. The studied patient had a C3 spinal cord injury. Ultrasound evaluation of diaphragm mobility showed that the patient suffered diaphragm dysfunction. A tracheotomy was indicated, and early ventilatory support was initiated. Ultrasound evaluation of diaphragm function in patients with cervical spinal cord injury is a useful and simple technique. It provides fast and reliable data for the diagnosis of respiratory insufficiency of neuromuscular origin.

ABSTRACT Objective: To determine the epidemic profile of patients with spinal fractures referred for evaluation by Spine Group of IOT-HCFMUSP between 2019 and 2022. To enable the effect of the Covid-19 Pandemic on these epidemic profiles. Methods: We retrospectively analyzed the medical records of patients with spinal fractures referred by the São Paulo Center for the Regulation of Health Offers and Services (CROSS) to the Spine Group of IOT-HCFMUSP between 2019 and 2022. The epidemiological profile between the pre-pandemic Covid-19 period and the period of the Covid-19 pandemic until December 2022 in the city of São Paulo was compared. Results: The medical records of 427 patients were analyzed between March 2019 and December 2022. During the period, males accounted for 71.9% of cases, and the mean age was 46.7 years. Falls from heights were the most frequent trauma mechanism (63.7%), followed by motorcycle accidents (14.3%). The absence of neurological deficit occurred in 76.8% of the cases, and the most injured region was the lumbar region (39.3%). There were changes in the epidemiological profile during the Covid-19 pandemic compared to the pre-pandemic. Conclusions: A predominance of middle-aged males was observed, in addition to the trauma mechanism of falling from a height, as well as the absence of a neurological deficit in the initial evaluation. The lumbar and cervical regions were the most frequent sites of injury. The pandemic period interfered with the epidemiological profile presented and in the time interval between the injury and the evaluation at the IOT-HCFMUSP. Level of Evidence IV; Case Series.

Study Design: Experimental study utilizing with a standardized model (MASCIS Impactor) of Spinal Cord Injury (SCI) in Balb C mouse model with implantation of mononuclear stem cells derived from the human umbilical cord and placenta blood in the early chronic phase of SCI., Objectives: The aim of this study was to evaluate the nerve regeneration and motor functional recovery in Balb C mice with surgically induced paraplegia in response to the use of mononuclear stem cells, in early chronic phase (> 2 weeks and < 6 months), because there is yet potential of neuronal and functional recovery as the neuronal scar is not still completely established., Methods: Forty-eight mice were randomly assigned to 6 groups of 8 animals. Group 1 received the stem cells 3 weeks after the trauma, and Group 2 received them six weeks later. In Group 3, saline solution was injected at the site of the lesion 3 weeks after the trauma, and in Group 4, 6 weeks later. Group 5 underwent only spinal cord injury and Group 6 underwent laminectomy only. The scales used for motor assessment were BMS and MFS for 12 weeks., Results: The intervention groups showed statistically significant motor improvement. In the histopathological analysis, the intervention groups had a lower degree of injury (p < 0.05). Regarding axonal budding, the intervention groups showed increasing in axonal budding in the caudal portion (p < 0.05)., Conclusions: The use of stem cells in mice in the chronic phase after 3 and 6 weeks of SCI brings functional and histopathological benefits to them., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2024 HCFMUSP. Published by Elsevier España, S.L.U. All rights reserved.)

Objectives: This study was conducted to investigate the factors affecting mortality due to spinal cord trauma in patients admitted to the intensive care unit (ICU)., Methods: This study was conducted in a group of patients who were admitted to the ICU with a Traumatic Spinal Injuries (TSI) diagnosis. The researcher started sampling by assessing the documents of the patients hospitalized in the ICU, and the diagnosis of TSI was confirmed for them. Besides, utilizing a researcher-made checklist, factors affecting the mortality of patients were identified. The data were analyzed using the SPSS software version 16. P<0.05 was considered statistically significant., Results: About 412 (64.2%) patients were men, about 213 (33.2%) of the patients had GCS between 3-8 grade. There were injuries in the pelvis area. Moreover, there was a significant relationship between GCS score status and the number of injury follow-ups in addition to TSI. Therefore, the mortality rate was higher in patients who had lower GCS (Odds ratio=2.32, p <0.001). There was also a significant relationship between the number of injuries and the mortality rate, and patients who had multiple traumas had a higher mortality rate. Besides, a significant relationship was observed between the complications caused by trauma, including cerebrovascular accident, cardiac arrest, acute respiratory distress syndrome (ARDS), pneumonia, and the mortality of patients hospitalized in the SICU ( p <0.05)., Conclusion: The patients' mortality was influenced by factors such as their level of consciousness, the number of traumas caused in the spinal cord, and the occurrence of comorbidities such as cerebrovascular accident, cardiac arrest, ARDS, and pneumonia. Therefore, it is necessary to take the essential measures to reduce these complications., Competing Interests: The authors declared that there was no conflict of interest., (© Bulletin of Emergency And Trauma (BEAT).)