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Substantial clinical data support an association between superior neurological outcomes and early (within 24 h) surgical decompression for those with traumatic cervical spinal cord injury (SCI). Despite this, much discussion persists around feasibility and safety of this time threshold, particularly for those with a complete cervical SCI. This study aims to assess clinical practices and the safety profile of early surgery across a large sample of North American trauma centers. Data were derived from the Trauma Quality Improvement Program database from 2010-2016. Adult patients with a complete cervical SCI (American Spinal Injury Association [ASIA] A) who underwent surgery were included. Patients were stratified into those receiving surgery at or before 24 h and those receiving delayed intervention. Risk-adjusted variability in surgical timing across trauma centers was investigated using mixed-effects regression. In-hospital adverse events including death, major complications, and immobility-related complications were compared between groups after propensity score matching. There were 2862 patients from 353 North American trauma centers included; 1760 (61.5%) underwent surgery within 24 h. Case-mix and hospital-level characteristics explained only 6% of the variability in surgical timing both between centers and within centers. No significant differences in adverse events were identified between groups. These findings suggest a relatively large proportion of patients are not receiving surgery within the recommended time frame, despite apparent safety. Moreover, patient and hospital-level characteristics explain little of the variability in time-to-surgery. Further knowledge translation is needed to increase the proportion of patients in whom surgery is performed before the 24-h threshold so patients might reach their greatest potential for neurological recovery.

Background: The knowledge of Emergency Medical Technicians (EMTs) plays a crucial role in the outcomes of traumatic patients. This study aimed to assess the knowledge of EMTs about the prehospital care intensity index of spinal cord trauma in Ilam Province, Iran. Materials and Methods: This cross-sectional study was conducted on 98 EMTs chosen by the census sampling method. The study data were collected using a researcher-made questionnaire on the prehospital care intensity index of spinal cord trauma and were analyzed with SPSS 16. Results: The knowledge of the prehospital care intensity index of spinal cord trauma was at the advanced level in 87.7% of EMTs and the intermediate level in 15.3% of EMTs. There was a significant relationship between the technician’s knowledge score and variables such as age, work record, overtime hours, and the number of missions (P˂0.05). Conclusion: EMTs needed more specialized information on spinal trauma. It was recommended to hold in-service training programs more precisely and consider the training of necessary skills that most EMTs require.

INTRODUÇÃO: O traumatismo Raquimedular (TRM) é caracterizado por uma lesão na medula espinal, que gera alterações nas funções motoras e sensitivas. Diante destas alterações que comprometem as condições de saúde dos indivíduos acometidos, a fisioterapia atua na reabilitação desses pacientes. OBJETIVO: Revisar a literatura científica e analisar a atuação fisioterapêutica e a qualidade de vida dos pacientes acometidos por TRM. MÉTODOS: Trata-se de uma revisão integrativa da literatura com a busca de artigos nas bases de dados: Scientific Electronic Library Online (SciELO), Biblioteca Virtual em Saúde (BVS), Literatura Latino-americana e do Caribe (LILACS) e PubMed, com a utilização do cruzamento de três descritores em inglês e português indexados respectivamente no Medical Subject Headings (MeSH) e Descritores em Ciências da Saúde (DeCS). Foram inclusos estudos publicados no período de janeiro de 2015 a maio de 2020. RESULTADOS: A Busca resultou em 8 artigos elegíveis para compor o escopo desta revisão. Verificou-se que a fisioterapia atua com diversas abordagens, tais como exercícios aeróbicos, uso da realidade virtual, eletroestimulação entre outros. As condutas encontradas nos estudos apresentaram efeitos benéficos que repercutem na qualidade de vida de indivíduos acometidos por TRM. CONCLUSÕES: Foi verificado que diversas abordagens fisioterapêuticas podem contribuir para a melhor qualidade de vida dos pacientes com TRM, sendo de suma importância o acompanhamento profissional especializado para o bem-estar físico e psicológico desses pacientes.

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. RESUMO Objetivo O presente estudo propõe uma análise retrospectiva relacionada ao traumatismo raquimedular de um hospital de referência regional em Ortopedia e Traumatologia pelo Sistema Único de Saúde (SUS), considerando dados epidemiológicos, comparações entre tratamentos e custos das internações. Métodos Trata-se de um estudo retrospectivo, analítico-descritivo de análise exploratória documental, utilizando dados de prontuários médicos de pacientes atendidos com traumatismo raquimedular durante o ano de 2016 no Hospital Municipal São José (Joinville – SC). Resultados Foram incluídos no estudo 23 pacientes, sendo 20 (87%) do sexo masculino. Quanto à etiologia, os acidentes de trânsito foram responsáveis por 47,8% dos casos e os ferimentos por arma de fogo ocuparam o segundo lugar com 26,1% dos agravos. A correlação entre o custo da internação e os dias da internação foi estatisticamente significativa (p=0,013), assim como a correlação entre o custo da internação e o número de procedimentos (p=0,000). Conclusões O tratamento cirúrgico demanda maior quantidade de recursos financeiros e humanos. O propósito do presente trabalho consiste em fornecer os dados epidemiológicos locais para fomentar a discussão de outros trabalhos, assim como o planejamento para alocação de recursos e de políticas públicas. Nível de evidência II; Estudo Retrospectivo. RESUMEN Objetivo El presente estudio propone un análisis retrospectivo relacionado al traumatismo raquimedular de un hospital de referencia regional en Ortopedia y Traumatología por el Sistema Único de Salud (SUS), considerando datos epidemiológicos, comparaciones entre tratamientos y costos de las internaciones. Métodos Se trata de un estudio retrospectivo, analítico-descriptivo de análisis exploratorio documental, utilizando datos de prontuarios médicos de pacientes atendidos con traumatismo raquimedular durante el año 2016 en el Hospital Municipal São José (Joinville - SC). Resultados Fueron incluidos en el estudio 23 pacientes, siendo 20 (87%) del sexo masculino. Cuanto a la etiología, los accidentes de tránsito fueron responsables por 47,8% de los casos y las heridas por arma de fuego ocuparon el segundo lugar, con 26,1% de los agravios. La correlación entre el costo de la internación y los días de internación fue estadísticamente significativa (p=0,013), así como la correlación entre el costo de internación y el número de procedimientos (p=0,000). Conclusiones El tratamiento quirúrgico demanda mayor cantidad de recursos financieros y humanos. El propósito del presente trabajo consiste en suministrar los datos epidemiológicos locales para fomentar la discusión de otros trabajos, así como la planificación para la asignación de recursos y de políticas públicas. Nivel de evidencia II; Estudio Retrospectivo.

SummarySpine and spinal cord injuries as a combat casualty are important in providingmilitary assistance to military personnel of the Armed Forces of Ukraine during combatoperation in eastern Ukraine and account for 1.1% of all sanitary casualties in thecontext of Antiterrorist Operation / Operation of Joint Forces. Such injury may be eventhree times more common in the structure of combat casualties. Often, injured patientswith spinal cord trauma remain unfit for further military service and require lifelongcare. Recently, treatment for recovery of sensory and motor function below the spinalcord injury area was primarily focused on traditional treatment and rehabilitationmethods, but new advances can significantly improve the prognosis of such patients,including the use of electrical stimulation devices. The case from this articledemonstrates the capabilities of such devices in the treatment of servicemen with spinalcord injury accompanied by impaired both motor and sensory function.

Individuals with cervical spinal cord injury (SCI) are at an increased risk for cardiovascular disease. Exercise is well-established for preventing cardiovascular disease; however, there are limited straightforward and safe exercise approaches for increasing the activity of the cardiorespiratory system after cervical SCI. The objective of this study was to investigate the cardiorespiratory response to passive leg cycling in people with cervical SCI. Beat-by-beat blood pressure, heart rate, and cerebral blood flow were measured before and throughout 10 minutes of cycling in 11 people with SCI. Femoral artery flow-mediated dilation was also assessed before and immediately after passive cycling. Safety was monitored throughout all study visits. Passive cycling elevated systolic blood pressure (5 ± 2 mm Hg), mean arterial pressure (5 ± 3 mm Hg), stroke volume (2.4 ± 0.8 mL), heart rate (2 ± 1 beats/min) and cardiac output (0.3 ± 0.07 L/min; all p < 0.05). Minute ventilation (0.67 ± 0.23 L/min), tidal volume (70 ± 30 mL) and end-tidal PO2 (2.6 ± 1.23 mm Hg) also increased (all p < 0.05). Endothelial function was improved immediately after exercise (1.62 ± 0.13%, p < 0.01). Passive cycling resulted in an incidence of autonomic dysreflexia. Therefore, passive leg cycling increased the activity of the cardiorespiratory system and improved endothelial function, indicating it may be a beneficial exercise intervention for the cardiovascular and respiratory systems in people with cervical SCI. Novelty: Passive leg cycling increases the activity of the cardiorespiratory system and improves markers of cardiovascular health in cervical SCI. Passive leg cycling exercise is an effective, low-cost, practical, alternative exercise modality for people with cervical SCI.

Available data on the pathogenesis, cellular interactions, role of inflammation, humoral and genetic factors in the formation of heterotopic ossifications resulting from injuries of the brain or spinal cord are presented.

Lesões traumáticas em coluna vertebral e medula espinhal ocorrem frequentemente na Medicina Veterinária, e o atropelamento por veículos automotivos é uma das causas mais prevalentes entre os cães. A fisioterapia veterinária, quando relacionada aos distúrbios locomotores e usada em conjunto com os tratamentos clínico e cirúrgico, tem o objetivo de restaurar, manter e promover a melhora da função e aptidão física, o bem-estar e a qualidade de vida do animal, facilitando sua rápida, e até completa, recuperação. Este trabalho relata os resultados do tratamento fisioterápico efetuado em um cão que apresentou diversas complicações em membros pélvicos, decorrentes de traumas na coluna vertebral e na medula espinhal, e destaca os benefícios da associação entre reabilitação e os tratamentos clínico e cirúrgico.

Spinal cord injury (SCI) initiates a severe, destructive inflammation with pro-inflammatory, CD68+/CD163−, phagocytic macrophages infiltrating the area of necrosis and hemorrhage by day 3 and persisting for the next 16 weeks. Inhibition of macrophage infiltration of the site of necrosis that is converted into a cavity of injury (COI) during the first week post-SCI, should limit inflammatory damage, shorten its duration and result in neuroprotection. By sustained subdural infusion we administered Serp-1, a Myxoma virus-derived immunomodulatory protein previously shown to improve neurologic deficits and inhibit macrophage infiltration in the COI in rats with the balloon crush SCI. Firstly, in a 7 day long study, we determined that the optimal dose for macrophage inhibition was 0.2 mg/week. Then, we demonstrated that a continuous subdural infusion of Serp-1 for 8 weeks resulted in consistently accelerated lowering of pro-inflammatory macrophages in the COI and in their almost complete elimination similar to that previously observed at 16 weeks in untreated SCI rats. The macrophage count in the COI is a quantitative test directly related to the severity of destructive inflammation initiated by the SCI. This test has consistently demonstrated anti-inflammatory effect of Serp-1 interpreted as neuroprotection, the first and necessary step in a therapeutic strategy in neurotrauma.

Neurotrauma (NT) is one of the common causes of mortality and morbidity. Investigating the role of people who had an impact on the development of knowledge of NT is reasonable. Our aim is to investigate the role of Bizhan Aarabi, professor of Neurosurgery, on the knowledge development in NT. Accordingly, we searched the Scopus database for Bizhan Aarabi on August 8, 2020 and selected papers with at least 10 citations, investigating his impact on NT and details of his publications. He has published 168 papers including original articles, reviews, conference papers, letters, and editorials according to the Scopus databases. There are 112 papers with 10 or more citations. Thirty-eight out of 112 papers (33.9%) were in the first and the highest rank journal: 29 in Neurosurgery and 9 in the Journal of Neurotrauma. Twenty-four papers have the level of evidence (LOE) of "1". Bizhan Arabi developed knowledge in NT especially in the cervical spine/spinal cord trauma and brain injury and his publications are references for spine/neurosurgeons.

Background Restoring community walking remains a highly valued goal for persons recovering from traumatic incomplete spinal cord injury (SCI). Recently, studies report that brief episodes of low-oxygen breathing (acute intermittent hypoxia, AIH) may serve as an effective plasticity-inducing primer that enhances the effects of walking therapy in persons with chronic (> 1 year) SCI. More persistent walking recovery may occur following repetitive (weeks) AIH treatment involving persons with more acute SCI, but this possibility remains unknown. Here we present our clinical trial protocol, designed to examine the distinct influences of repetitive AIH, with and without walking practice, on walking recovery in persons with sub-acute SCI ( Methods To test our hypothesis, we are conducting a randomized, placebo-controlled clinical trial on 85 study participants who we stratify into two groups according to walking ability; those unable to walk (non-ambulatory group) and those able to walk (ambulatory group). The non-ambulatory group receives either daily AIH (15, 90s episodes at 10.0% O2 with 60s intervals at 20.9% O2) or daily SHAM (15, 90s episodes at 20.9% O2 with 60s intervals at 20.9% O2) intervention. The ambulatory group receives either 60-min walking practice (WALK), daily AIH + WALK, or daily SHAM+WALK intervention. Our primary outcome measures assess overground walking speed (10-Meter Walk Test), endurance (6-Minute Walk Test), and balance (Timed Up & Go Test). For safety, we also measure levels of pain, spasticity, systemic hypertension, and autonomic dysreflexia. We record outcome measures at baseline, days 5 and 10, and follow-ups at 1 week, 1 month, 6 months, and 12 months post-treatment. Discussion The goal of this clinical trial is to reveal the extent to which daily AIH, alone or in combination with task-specific walking practice, safely promotes persistent recovery of walking in persons with traumatic, subacute SCI. Outcomes from this study may provide new insight into ways to enhance walking recovery in persons with SCI. Trial registration ClinicalTrials.gov, NCT02632422. Registered 16 December 2015

Objective: To describe and analyze characteristics of cases of spinal cord Trauma (SCT) among traffic accident victims admitted to a referral hospital. Method: Descriptive, analytical, cross-sectional study with quantitative approach, developed in the city of Campina Grande, in the state of Paraíba, Brazil. The population consists of 1,884 medical records of patients admitted to hospital after damage caused by traffic accidents from January to December 2016. Data were analyzed using descriptive and inferential statistics, adopting a significance level of 5%. Results: Among the victims of traffic accidents, there was a male predominance (85.4%). The most affected age group was 21 to 30 years (29%). Accidents involving motorcyclists were predominant (82.9%) and 43 victims (2.3%) suffered spinal injury. Among these ones, there was a prevalence of males (86%), in the age group between 21 and 30 years (35.7%). In 30 cases (69.8%), the victims had spinal injuries. The cervical level (55.8%) was dominant. In addition, 46.7% of the victims were classified as ASIA and there were 9 cases (30%) of paraplegia and 1 case (3.3%) of tetraplegia. A bivariate analysis revealed a significant association between the variable presence of SCT and type of accident (p

Spine traumas and the resulting spinal cord injuries are among the most important health problems with their physical and psychosocial impacts due to significant mortality and morbidity. Our objective in this study was to evaluate the issues that should be taken into consideration during the intensive care treatment management of patients monitored for spinal cord trauma. Patient files were examined for obtaining the demographic and clinical properties of 68 patients followed up with spine trauma diagnosis at the Intensive Care Unit during the dates of June 2011- 2016. Age, gender, cause of trauma, trauma localization, trauma injury accompanying the spine trauma, deep vein thrombosis development, infection development, ASIA (American Spinal Injury Association) score, duration of intensive care stays, and properties were examined. An evaluation was made in our study according to ASIA scoring as a result of which it was determined that there are 4 ASIA A patients (5.88%) hospitalized or discharged, 5 ASIA B patients (7.35%), 14 ASIA C patients (20.58%), 24 ASIA D patients (35.29%) and 5 ASIA score E (neurologically intact) (7.35%) patients, while mortality rate was determined as 16 patients (23.52%). It was determined as a result of the evaluation carried out with regard to post-trauma intensive care unit length of stays that the average length of stay was 21.3 days with the shortest length of stay as 1 day and the longest as 96 days. Care attributes should be familiar for this patient group that requires a multidisciplinary approach and serious rehabilitation and a sufficient level of knowledge should be reached by all those involved in the follow-up procedure. [Med-Science 2018; 7(3.000): 561-4]

Objective The zero-profile implant (Zero-P) is accepted for use in anterior cervical fusion for the treatment of degenerative cervical disease. However, evidence pertaining to its efficiency and safety in traumatic cervical injury is largely insufficient. This study aimed to compare the overall outcomes of patients who underwent Zero-P for traumatic cervical disc injury. Methods Data from a total of 53 consecutive patients who underwent surgery for traumatic or degenerative cervical disc disease using the Zero-P were reviewed. Seventeen patients (group A) had traumatic cervical disc injury and the remaining 36 (group B) had degenerative cervical disc herniation. The fusion and subsidence rates and Cobb angle were measured retrospectively from plain radiographs. The patients' clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) score and Odom's criteria. Results The C2-7 Cobb and operative segmental angles increased by 3.45±7.61 and 2.94±4.59 in group A; and 2.46±7.31 and 2.88±5.49 in group B over 12 postoperative months, respectively. The subsidence and fusion rate was 35.0% and 95.0% in group A; and 36.6% and 95.1% in group B, respectively. None of the parameters differed significantly between groups. The clinical outcomes were similar in both groups in terms of increasing the JOA score and producing a grade higher than "good" using Odom's criteria. Conclusion The application of Zero-P in patients with traumatic cervical disc injury was found to be acceptable when compared with the clinical and radiological outcomes of degenerative cervical spondylosis.

Objective is to analysis of literature data, which analyzed the treatment data for patients with single and multiple spinal trauma at the thoracic and lumbar levels. Materials and methods. The article analyzes 98 sources of domestic and foreign sewers published from 1971 to 2015, which reflect the issues of epidemiology, classification, clinical course, tactics of surgical treatment of patients with single and multiple vertebral-spinal trauma at thoracic and lumbar levels. In the sources, the results of treatment of long-term observations were performed. Results. In the structure of spine and spinal cord trauma, its weighting is noted: an increase in the proportion of combined and complicated injury. Also in recent years there has been an increase in the number of multiple (5–20 %) and multilevel (3–50 %) spinal injuries. Despite the widespread use of modern diagnostic methods, such as computer and magnetic resonance imaging, the widespread distribution of X-ray diagnostics, multiple spinal injuries are not diagnosed in all cases or not in full. A huge number of both russian and foreign works is devoted to the diagnosis and treatment of vertebral-spinal trauma in general. The works highlight some aspects of diagnosis, tactics of management, scope and timing of surgical treatment for trauma to the spinal cord and spinal cord with lesions at various levels. However, there is a small number of publications, both in foreign and russian literature, devoted specifically to the diagnostic search features and tactics of surgical treatment of patients with multiple vertebral-spinal trauma. None of the work fully covers the tactics, sequence and features of treatment with multiple spine and spinal trauma. Conclusion. Improvement of the diagnostic algorithm and development of optimal tactics for surgical treatment, prevention of complications and reduction of mortality in the group of these patients require more detailed specification and study, which will be of great practical interest.

Introdução: O Trauma Raquimedular (TRM) é uma lesão traumática na coluna vertebral ou na medula espinhal que pode variar de lesões sem acometimento neurológico até traumas graves. Os traumas de coluna vertebral são mais prevalentes em indivíduos do sexo masculino, com idade entre 20 e 40 anos. Os traumas decorrentes de quedas de alturas muito elevadas geralmente cursam com algum déficit das funções neurais e, em muitos casos, se associam com tetraplegias e paraplegias. O objetivo desse trabalho é relatar o caso clínico de uma paciente de 12 anos que sofreu TRM por queda de uma altura de 10 metros, sem desenvolvimento de danos neurológicos e apresentando bom estado geral. Relato do caso: JPD, 12 anos, feminino, vítima de queda de 10 metros de altura sobre os pés, após 4 dias de internação evolui com quadro de dor lombar intensa. Após realizada a tomografia computadorizada (TC) de coluna vertebral, identificou-se fratura instável e complexa em vértebra L1. Apesar disso, a paciente manteve função sensitiva e motora normais (Frankel E). Paciente manteve-se estável, em imobilização de coluna, apresentando dor lombar moderada somente à movimentação até a realização de cirurgia de correção de fratura da vértebra. Discussão: No caso apresentado, o nível de compressão do canal medular e a gravidade da fratura estariam propensos a causar danos neurológicos a partir do nível de L1. O fato de a paciente não apresentar danos neurológicos tem importância clínica por representar um curso atípico e que tem levantado questionamentos quanto à relação entre o grau de compressão medular visualizado à TC e o real dano neural. E, também, questionamentos acerca da realização de exames de imagem apenas devido ao mecanismo agressivo do trauma. Além disso, a faixa etária e o sexo feminino fogem ao que é descrito na literatura como mais prevalente.

Objective This study was done with the aim to compare the clinical outcome and patient's quality of life between early (within 24 hours post-injury) versus delayed (after 24 hours to 7 days) surgically treated patients of acute cervical spinal cord injury. The current study was based on the hypothesis that early surgical decompression and fixations in acute cervical spinal cord trauma are safe and are associated with improved outcome as compared with delayed surgical decompression. Methods A total of 54 patients were recruited and divided into early decompression surgery group A (operated within 24 hours of trauma; n = 25) and late/delayed decompression surgery group B (operated between 24 hours and 7 days of trauma; n = 29). The patients in both groups were followed up, and comparative differences noted in the neurological outcome, quality of life, and bony fusion. Results The early surgery group had lesser postoperative complications. In group A, 54.17% patients had 1 American Spinal Injury Association Impairment Scale (AIS) grade improvement, while 29.17% experienced > 2 AIS grade improvement (p = 0.015). In group B, the neurological improvement was 50 and 21.43%, respectively (p = 0.003). There was a significant improvement in the postoperative quality of life scores in early surgery group. Conclusion Early surgery in patients with acute cervical spinal cord injury should be considered strongly in view of the lesser complications, better neurological recovery, and reduced mortality.

Spinal cord injuries represent a special category of injuries in traumatic pathology, with high morbidity and mortality, which justify their analysis with the aim to identify useful aspects in order to prevent and treat them. We therefore performed a retrospective study on 426 cases in order to analyze epidemiology and medico-legal issues related to spinal cord injuries. The studied items regarded socio-demographic aspects (gender, age, home region), type of lesions (vertebral, spinal cord, association with other trauma), circumstances leading to trauma (cause of the injury, season), data regarding hospitalization (medical condition at the hospital admission, number of days of hospitalization, clinical diagnosis, imaging exploration level) and data resulting from autopsy (diagnosis, toxicological examination). Most of our results are consistent with literature data, except for some epidemiological items, which might be explained with cultural differences, life style and inhomogeneous population. Based on our results, the general conclusion is the need for prevention campaigns, focusing on road traffic accidents and falls (especially in elderly) as the main causes of spinal cord injuries.

Objective People living with spinal cord injuries are at a high risk to experience preventable secondary health conditions in their lifetime, which can lead to rehospitalisation and death. Given the fact that spinal cord injury is a long term disability requiring on-going care, there is need to strengthen prevention of secondary health conditions. This study aims to establish factors influencing prevention care for secondary health conditions among people living with spinal cord injuries in a metropolitan area in order to develop a prevention model of care. Results A record review of patients living with spinal cord injuries will be conducted to identify the prevalence of secondary health conditions and associated factors. Semi-structured interviews will be conducted on patients living with spinal cord injuries, their caregivers and therapists to explore the contextual factors (personal and environmental factors) influencing the prevention of secondary health conditions. Thematic analysis will be used to identify the themes. Nominal group technique will be used to develop the prevention model of care for secondary health conditions. This study will be conducted at a tertiary and specialised rehabilitation hospital in South Africa.

Aim Prevalence and incidence of spinal cord injury (SCI) are low. However, sample sizes have not been systematically examined yet, although this might represent useful information for study planning and power considerations. Therefore, our objective was to determine the median sample size in clinical trials on SCI individuals. Moreover, within small‐sample size studies, statistical methods and awareness of potential problems regarding small samples were examined. Methods We systematically reviewed all studies on human SCI individuals published between 2014 and 2015, where the effect of an intervention on one or more health‐related outcomes was assessed by means of a hypothesis test. If at least one group had a size

The translation of therapeutic interventions to humans with spinal cord injury with the goal of promoting growth and repair in the central nervous system could, inadvertently, drive mechanisms associated with the development of neuropathic pain. A framework is needed to evaluate the probability that a therapeutic intervention for acute spinal cord injury modifies the progression of neuropathic pain. We analyzed a large, longitudinal dataset from the European Multi-Center Study about Spinal Cord Injury (EMSCI) and compared these observations with a previously published Swedish/Danish cohort. A meta-analysis was performed to produce aggregate estimates for the transition period between 1-6 months and the transition period between 1-12 months after injury. A secondary analysis used logistic regression to explore associations between the progression of neuropathic pain and demographics, pain characteristics, and injury characteristics. For overall neuropathic pain, 72% presenting with pain symptoms at one month reported persisting symptoms at six months, and 23% who did not have neuropathic pain at one month later had it develop. From 1-12 months, there was a similar likelihood of pain persisting (69%) and slightly higher rate of pain developing (36%). Characteristics that were significantly associated with the progression of pain included age and sensory and motor preservation. We provide historical benchmarks for estimating the progression of neuropathic pain during the first year after acute SCI. This information will be useful for comparison and evaluating safety during early phase acute spinal cord injury trials.

Objetivo: caracterizar el perfil de funcionamiento de los pacientes con secuelas de traumatismos de la médula espinal, mediante whodas 2.0 (Cuestionario para la Evaluación de la Discapacidad de la Organización Mundial de la Salud 2.0), en el municipio de Samacá, Boyacá (Colombia). Métodos: se realizó un estudio transversal, se evaluaron registros de whodas 2.0. Esta herramienta fue aplicada mediante entrevista a todos los pacientes con secuelas de traumatismos de la médula espinal que residían en el municipio de Samacá entre agosto y septiembre de 2019 y que estaban registrados en las bases de datos de las instituciones de salud del municipio. Resultados: se analizaron los registros de doce pacientes, cuyo nivel de lesión fue torácico en su mayoría. El grado de discapacidad global fue leve en 58.3% de los pacientes y moderado en 41.7%. Por dominios, la discapacidad en movilidad y participación se presentó en 100% de los pacientes. Otros dominios afectados fueron las actividades de la vida diaria, con compromiso principalmente en los ítems correspondientes a trabajo y tareas domésticas, y el dominio de relaciones en el ítem correspondiente a dificultad en la actividad sexual. Conclusiones: los dominios funcionales más afectados en los pacientes con traumatismos de la médula espinal fueron movilidad y participación. El whodas 2.0 es útil en la evaluación del perfil funcional y facilita la creación de programas de rehabilitación basada en la comunidad dirigidos a mejorar la funcionalidad de estos pacientes.

Objective: To determine the effectiveness of the Phosphodiesterase 5 (PDE5) Inhibitors for the treatment of erectile dysfunction in patients with spinal trauma. Methods: A systematic review and meta-analysis comparing PDE5 inhibitors versus placebo were carried out for clinical trials conducted between 1980 and 2014 that evaluated male patients older than 18 years, diagnosed with spinal cord trauma and erectile dysfunction. We designed a search strategy for Medline, CENTRAL, EMBASE and other electronic sources. Two investigators independently and blindly screened the studies for inclusion. A random effect meta-analysis was performed. Results: Six studies involving 963 patients were included. Male patients over 18 years with ED attributable or subsequent to traumatic spinal cord injury (SCI) were included from these studies. In 4 of these studies, patients were randomized to the treatment group receiving sildenafil and the comparison group was placebo. Out of the remaining 2 trials, one compared tadalafil against the placebo and the other vardenafil versus placebo. The improvement on SCIs with PDE5 inhibitors was found to be large (standardized mean difference 0.71; 95% CI 0.39-1.03), with a high heterogeneity (I2 = 74.4%). Conclusions: PDE5 inhibitors are effective for the treatment of erectile dysfunction secondary to SCI. © 2016 S. Karger AG, Basel.

Spinal cord injuries (SCI) with their tragic consequences belong to the most serious pathological conditions. That is why they have stimulated basic research workers, as well as health care practitioners, to search for an effective treatment for decades. Animal experimental models have been essential in these efforts. We have jointly decided to test and standardize one of the spinal cord injury compression models in rats. Twentythree adult female Wistar rats weighing 250-320 g were utilized. Employing general anaesthesia along with a mixture of sevoflurane with O2, 2 rats (sham controls) had their vertebral arch of either Th8 or Th9 vertebra removed (laminectomy). The other 21 experimental rats with similar laminectomies were divided into 3 subgroups (n = 7) which received compression impact forces of 30, 40 or 50 g (subgroups-1, -2, and -3, respectively) applied on their exposed spinal medulla for 15 minutes. All rats were observed for 28 days after the experimental procedure and their motor functions were assessed by the Basso, Beattie, Bresnahan (BBB) test 6 hours, 7, 21 and 28 days after the simulated SCI. All 23 rats survived the surgical procedures. The control rats were without any neurological deficits. There were, in every experimental subgroup, 1 or 2 rats with extreme BBB scores. So the rats with the maximum and minimum BBB values were excluded. Then, the results acquired in the residual 5 rats in each group were averaged and statistically analysed by the Tukey multiple comparisons test. Statistically significant intersubgroup differences were found at all survival times equal to or longer than 7 post SCI days. The goal of the SCI experiment was to generate a reproducible and reliable, submaximal spinal cord trauma model. The statistical analyses demonstrated that this objective was best achieved in the subgroup-2 with the 40 g compression.

Subarachnoid pleural fistulas are rare. They have been described as complications of thoracic surgery, penetrating injuries and spinal surgery, among others. We present the case of a 3-year-old female child, who suffer spinal cord trauma secondary to a car accident, developing a posterior subarachnoid pleural fistula. To our knowledge this is the first reported case of a pediatric patient with subarachnoid pleural fistula resulting from closed trauma, requiring intensive multimodal management. We also present a management algorithm and a proposed classification. The diagnosis of this pathology is difficult when not associated with neurological deficit. A high degree of suspicion, multidisciplinary management and timely surgical intervention allow optimal management.

Spinal immobilisation has long been an accepted part of pre-hospital care. There is, however, a lack of evidence that spinal immobilisation is effective in reducing spinal cord injury (SCI). The aim of this article is to review a broad range of literature in relation to spinal immobilisation and consider some of the current controversies. Despite a lack of high-quality research, following a comprehensive literature search, 13 pieces of primary research and 4 pieces of secondary research were identified. The literature identified a number of potential controversies relating to the principal effectiveness of immobilisation, side effects of immobilisation and patient outcome in comparison to non-immobilised patients. Given these areas of controversy, many of which are of fundamental importance, it seems logical that further high-quality research is required to establish whether spinal immobilisation is effective or otherwise.

We present a clinical observation of a pathological fracture of the spine in a patient with ankylosing spondylitis (Bechterew's disease). The results of a comprehensive radiological assessment (X-ray, multidetector computed tomography, magnetic resonance imaging), which enabled the differential diagnosis with a tumor and inflammatory processes and to determine a management strategy.

Objective. To assess the dynamics of neurological disorders in children with spine and spinal cord trauma in the thoracic and thoracolumbar spine, depending on the timing of surgery and the severity of spinal cord injury. Material and Methods . A total of 36 children aged 3 to 17 years were operated on for injuries to the thoracic spine and thoracolumbar junction accompanied by neurological deficit. Thoracic spine was damaged in 16 (44.4 %), thoracolumbar junction - in 20 (55.6 %) patients. Patients were divided into four groups based on time to surgery. Spinal bone lesions were assessed according to Magerl’s classification, and neurological disorders - to the ASIA scale. Results . Long-term results were followed for 5 years in all patients. Neurological function improvements in patients of Group 1 were observed in 1-2 days after surgery, Group 2 - in 2-3 days, Group 3 - in 5-7 days, and Group 4 - in 4-5 months. In Group 1 positive dynamics was observed as significant regression of sensory disorders, in Group 2 - as complete regression of neurological deficit in 2 patients, in Group 3 - as transition from C to D grade in 4 patients, from B to D grade in 2 patients, and 2 children had no regression. In Group 4 a regression of neurological disorders from B to C grade was observed in 6 children in 2-3 years, and 10 patients (A grade) had no improvement in neurological status. Conclusion . Complete and rapid recovery of neurological functions in children with complicated fractures of thoracic and thoracolumbar spine is observed after surgical treatment performed within the first 6-12 hours after injury, when neurological deficit is mainly caused by compression of the spinal cord and its elements, and secondary circulatory and pathological changes have not yet expressed.

Aim: Prevention of secondary injury developing as a result of spinal cord injury will reduce significantly neurological deficits which may occur after trauma. These are focused in experimental studies and many agents are being tested. In our study, we have invesitigated the effects of kefir, which is a a probiotic, associated with life prolongation, whose antioxidant and lipid peroxidation effects were revealed on despite the scientific studies were limited, on lipid peroxidation and lysosomal proteases which play important roles in spinal cord. Material and Method: In the study, female Sprague Dawley rats weighing 200 to 250 g were used. The study was conducted on five groups with a total of 40 rats including the control, trauma, trauma treatment, trauma treatment kefir and trauma kefir groups. The high-dose methylprednisolone was used as the therapy. Spinal cord trauma was performed with clip compression method at the level of T10. Kefir was given to rats via orogastric ways, prior to trauma for 7 days at a dose of 2 * 1cc/100g. All rats were sacrificed 48 hours after treatment. The changes in the value of tissue cathepsins B and L, MDA and histopathological changes were examined. Results: It has been found in our study according to the review of biochemical values that; kefir did not reduce significantly cathepsin B values compared to the treatment group (p> 0.05), did reduce significantly MDA value compared to treatment group (p

SUMMARY OBJECTIVE: To present the surgical results of patients who underwent axis screw instrumentation, discussing surgical nuances and complications of the techniques used. METHODS: Retrospective case-series evaluation of patients who underwent spinal surgery with axis instrumentation using screws. RESULTS: Sixty-five patients were included in this study. The most common cause of mechanical instability was spinal cord trauma involving the axis (36 patients – 55.4%), followed by congenital craniocervical malformation (12 patients – 18.5%). Thirty-seven (57%) patients required concomitant C1 fusion. Bilateral axis fixation was performed in almost all cases. Twenty-three patients (35.4%) underwent bilateral laminar screws fixation; pars screws were used in twenty-two patients (33.8%), and pedicular screws were used isolated in only three patients (4.6%). In fourteen patients (21.5%), we performed a hybrid construction. There was no neurological worsening nor vertebral artery injury in this series. CONCLUSION: Axis screw instrumentation proved to be a safe and efficient method for cervical stabilization. Laminar and pars screws were the most commonly used RESUMO OBJETIVO: Apresentar os resultados cirúrgicos de pacientes submetidos à instrumentação com parafusos do áxis, discutindo nuances cirúrgicas e complicações das técnicas utilizadas. MÉTODOS: Série retrospectiva de pacientes submetidos à instrumentação do áxis utilizando parafusos. RESULTADOS: Sessenta e cinco pacientes foram incluídos neste estudo. A causa mais comum de instabilidade foi trauma raquimedular envolvendo o áxis (36 pacientes – 55,4%), seguida por malformação craniocervical congênita (12 pacientes – 18,5%). Trinta e sete (57%) pacientes necessitaram concomitante fusão de C1. Fixação bilateral foi realizada em quase todos os casos. Vinte e três pacientes (35,4%) foram submetidos à fixação com parafusos de lâmina; parafusos de pars foram utilizados em 22 pacientes (33,8%) e de pedículo, isoladamente, em três (4,6%). Em 14 casos (21,5%), realizamos técnicas combinadas. Não houve piora neurológica ou lesão de artéria vertebral nesta série de casos. CONCLUSÃO: A instrumentação com parafusos do áxis foi um método seguro e eficaz para estabilização cervical. A fixação da lâmina e a da pars foram as técnicas mais utilizadas.

The Abbreviated Injury Scale (AIS) is an internationally accepted coding system created by the Association for the Advancement of Automotive Medicine, utilized to code traumatic injuries as a function of severity, the latter often defined as mortality risk. Periodic reassessment of that risk is prudent, in light of advances in health care and relationship of nonanatomic factors to death.The objective of this study was to reevaluate the risk of death associated with spine fractures with and without neurologic deficit, age factors associated with it, and the impact of hospital coding on the accuracy of these efforts.Medical records and imaging of patients treated at a level 1 trauma center from 2014 through 2016 with discharge International Classification of Diseases, 10th revision (ICD-10) diagnoses of spinal trauma and spinal cord injury (SCI) were reviewed. Data were collected on demographics, complications, neurologic status, and outcomes.Three hundred seventy patients met the criteria for inclusion in this effort. Errors in ICD-10 discharge codes were seen in 45% of the cases, both false positive and negative. One hundred thirty-four patients, with a mean age of 45, were admitted with neurologic deficit. There were 8 SCI-related deaths; 2 were postoperative out of 110 undergoing surgical treatment. All deaths in this group were in patients with upper level SCI, with a mean age of 68. Ten patients had spontaneous neurologic improvement within 24 h. One hundred nineteen patients without deficit had AIS 2 scored fractures; there was one postoperative death out of 47 patients undergoing surgical treatment. One hundred seventeen patients without deficit suffered AIS 3 fractures; 66 underwent surgery without any deaths. There was one nonoperative death. Age and high quadriplegia were the only factors associated with mortality.Mortality risk in patients with deficit was associated more with age at injury than extent of anatomic injury. Spine trauma without neurologic deficit is benign in younger populations and AIS scores could be age adjusted. Mortality risk is higher in high cervical injuries with neurologic deficit and in the elderly. An incidental finding is that demographic studies based solely on discharge ICD coding may contain errors and should be considered critically.

Objective: to raise the intestinal pattern and control measures adopted by adult individuals with spinal cord trauma. Method: exploratory descriptive study with quantitative approach. Sample of 14 adults with spinal cord trauma. The data collection was done through an interview in the domiciles of the participants. Results: predominance of men; the automobile accident was the main etiology of traumas. Most individuals demonstrated independence for intestinal self-care and the most frequent practices were digitrectal stimulation, abdominal massage and manual extraction of faeces. 92.9% of the individuals attended or had already attended the Specialized Center in Rehabilitation. Conclusions: nursing exercises an important role in the teaching of patient and family selfcare, so it needs skills and knowledge that allow the planning of actions for teaching the care of intestinal disorders, with appropriate interventions aimed at preventing potential complications and improving quality of life of these individuals.

Введение. Сочетанные повреждения, компонентом которых является позвоночно-спинномозговая травма, давно стали не только медицинской, но и социальной проблемой. При множественных и сочетанных повреждениях диагностика травм позвоночника у пострадавших должна носить характер не подтверждения, а исключения возможного повреждения. Цель. Оценка тяжести, прогноза и исходов, а также анализ особенностей оказания медицинской помощи при позвоночно-спинномозговой травме у шахтеров на догоспитальном этапе. Материалы и методы. Проведен анализ исходов лечения 146 пострадавших шахтеров с позвоночно-спинномозговой травмой. Средний возраст пострадавших составил 37,7±0,8 года. У 12 (8,2 %) пострадавших была изолированная травма, у 21 (14,4 %) – множественная и у 113 (77,4 %) – сочетанная. В 67 наблюдениях (45,9 %) позвоночно-спинномозгова травма являлась доминирующей. Медицинская помощь на догоспитальном этапе оказывалась врачами реанимационно-противошоковых групп государственной военизированной горноспасательной службы. Результаты. На догоспитальном этапе смертельных исходов не было. Гибель пострадавших отмечалась в 8 случаях (5,5 %) в условиях лечебного учреждения. У 6 пациентов были тяжелые сочетанные повреждения грудной клетки, живота, таза; в двух случаях доминирующей была травма позвоночника с повреждением спинного мозга. Заключение. Для определения тяжести и прогноза исходов травм на догоспитальном этапе целесообразно использовать интегральный прогностический показатель, а для выделения доминирующего повреждения – балльную оценку шокогенности травмы. Ключевые слова: политравма, позвоночно-спинальные повреждения.

Objective Analyze the predictors of prognosis in patients with spinal cord trauma (SCT) in a tertiary hospital. Method Study prospective with 321 patients. The analysis focused on patient-related data, cause of accident, anatomical distribution, neurologic status, associated injuries, length of hospital stay, and in-hospital complications/mortality. Results The SCT was more common in men, but women older than 50 years presented a higher risk than men of the same age. Automobile accidents, motorcycle accidents, and gunshots resulted in more injuries associated. The cervical spine involvement was directly related to an increase in the number of associated injuries, complications, and mortality. Already, the neurologic status ASIA-A was associated with an increase in the number of complications, length of stay, and mortality. Conclusion The predictive factors of prognosis in these patients included age, sex, cause of injury, anatomic distribution, and neurologic status.

Uma lesão medular traumática pode resultar em perdas importantes de diversas funções do organismo, caracterizando assim uma deficiência adquirida. Nesta pesquisa, buscou-se compreender as vivências de pacientes hospitalizados, recém-diagnosticados com um trauma raquimedular, desvelando os significados atribuídos a este acometimento e a consequente deficiência adquirida. Trata-se de uma investigação qualitativa, de caráter exploratório, descritivo, com ênfase nas singularidades dos casos. Participaram dois pacientes do sexo masculino, com idade de 35 e 40 anos, internados em um hospital público, referência em traumas, localizado na região norte do Brasil. Os resultados revelaram perdas significativas como a perda da autonomia e temores relacionados à discriminação e o abandono. Identificou-se que a deficiência adquirida na fase adulta explicita o desafio de ressignificar diferentes aspectos do ser e do viver, o que sinaliza a importância do desenvolvimento de pesquisas acerca da assistência integral a estes pacientes desde o momento do diagnóstico, favorecendo a vivência das perdas sofridas e adaptação à nova condição de vida.

Replacement of the removal site of the spinal cord on a collagen implant restores the motor function of the hind limbs in rats to the level of movements in the two joints for 8 weeks. After intravenous administration of mononuclear cells of human umbilical blood, recovery accelerated, significantly improved to the level of motion in the three joints, and there is a tendency to improve further recovery of movements.

The cervical spine is an anatomically complex structure whose essential roles are to orient the head and the sensory system and to protect the spinal cord. In developed countries, sports related accidents constitute the fourth most common cause of spinal cord trauma. They are the second most frequent case of spinal cord injuries for those under the age of 30. All sports are potentially affected even though it would seem that highly kinetic physical activities or contact sports would be the most concerned. In this chapter, we will first review the anatomy of the cervical spine and then describe the biomechanical basis of the protective effect of the cervical musculature and the neurophysiological aspects of trauma prevention. We will describe how cervical muscles can be evaluated and close with a brief overview of preventative strategies of the French Rugby Federation will be described.

Background context Spinal cord trauma is a major cause of mortality and morbidity. Although no known treatment for spinal cord injury exists, a limited number of effective treatment modalities and procedures are available that improve secondary injury. Hyperbaric oxygen (HBO) treatment has been used to assist in neurologic recovery after cranial injury or ischemic stroke. Purpose To report the findings on the effectiveness of HBO treatment on rats with experimental traumatic spinal cord injury. Improvement was evaluated through motor strength assessment and nitrite level assay testing. Study design We randomly distributed 40 rats among 5 groups of 8 rats each: sham incurable trauma, induced trauma, HBO treatment begun at the 1st hour, HBO treatment begun at the 6th hour, and HBO treatment begun at the 24th hour. Method The HBO treatment was administered to rats in three of the groups and conducted in two 90-minute sessions, under an absolute atmospheric pressure of 2.4 at 100% oxygen for 5 days. In the motor strength evaluations, all the rats were observed during the inclined plane test and clinical motor examination on the first, third, and fifth days. In addition, the nitrite levels of spinal cord tissues on the sixth day were also studied. Results Results from the inclined plane levels and motor strength test from all the three groups undergoing HBO treatment were higher than those from Group 2. It was also determined that early HBO treatment resulted in higher recovery rates (groups 3 and 4). The highest levels were seen in the group in which the HBO treatments were started in the first hour (Group 3). It was noted that nitrite levels of rats in the group exposed to trauma increased, compared with the sham group, but increased levels also diminished after HBO treatments. Again, the greatest decrease in nitrite levels was evident in the group where the HBO treatment was started the earliest (Group 3). Conclusions Prompt HBO treatment after trauma significantly contributed to the clinical, histopathologic, and biochemical recovery of the rats.

Secondary injury following initial spinal cord trauma is uncommon and frequently attributed to mismanagement of an unprotected cord in the acute time period after injury. Subacute posttraumatic ascending myelopathy (SPAM) is a rare occurrence in the days to weeks following an initial spinal cord injury that is unrelated to manipulation of an unprotected cord and involves 4 or more vertebral levels above the original injury. The authors present a case of SPAM occurring in a 15-year-old boy who sustained a T3–4 fracture-dislocation resulting in a complete spinal cord injury, and they highlight the imaging findings and optimum treatment for this rare event.

Introduction . The progressive mechanisation of work in every area of life and the rapid development of means of transport have a major impact on the steadily increasing number of injuries. Spinal injuries are a major medical problem due to the complex structure of the spine, and particularly the neural elements located in the spine. Aim . The analysis of causes, the number and type of injuries of the spine and spinal cord trauma performed on the basis of the documentation from the Emergency Department (ED) of Lower Silesia Specialized Hospitalname Tadeusz Marciniak in Wroclaw and documentation from the Clinic and the University Clinical Hospital (UCH) in Wroclaw. Material and Methods . A retrospective analysis was performed on the documentation of 530 patients from the ED at Lower Silesia Specialized Hospital name Tadeusz Marciniak in Wroclaw who suffered a back injury and/or spinal cord injury and 45 patients from the Clinic and the Department of Neurosurgery at UCH in Wroclaw who were treated for a spine injury and spinal cord injury. Results . The analysis of the study material shows that: — more than a half of the ED patients (58.87%) and 44% of those hospitalized in the Department of Neurosurgery suffered a spinal injury during a traffic collision; — more men were patients in the Department of Neurosurgery (60%), whereas among the ED patients women were slightly more often hospitalized because of a spine injury (52.64%); — the vast majority of respondents with spinal injury were brought to hospital by emergency teams. Conclusions. 1. The predominant reason for spinal injuries and spinal cord injuries being motor vehicle accidents. 2. Mainly young people aged 20–35 years suffer spine and spinal cord injuries. 3. Spine injury most often refers to the cervical part of the spine. (JNNN 2014;3(4):153–156)

Current practice of spinal immobilisation appears to be based heavily on historical practice rather than scientific precedence. Evidence shows that it is common practice to immobilise patients, yet studies demonstrating the benefit of this is limited. The decision made by the clinician to immobilise a patient is based on fear of reprisal, caution and ritualised practice rather than robust clinical assessment or a definitive criteria. A global, standardised criteria and robust immobilisation method is yet to be established. This article will examine and critically analyse existing literature surrounding patient immobilisation following a suspected or confirmed acute neck injury. In particular, literature on the use of a cervical collar and head blocks and the use of clinician decision tools will be critically analysed.

Fibrocartilaginous Embolism (FCE) refers to the extrusion of some of the fibro-cartilaginous nucleus pulposus material from within the inter-vertebral disc to eventually embolize into one of the spinal cord vessels with resultant spinal cord infarction. According to a 2016 review, AbdelRazek et al. (2106) [1] there are 41 pathologically confirmed and 26 clinically suspected cases in the literature till the end of 2015. We add two more clinically diagnosed cases.

N-acetylcysteine (NAC) is an antioxidant agent that has been shown to have beneficial effects when treating various diseases. The aim of this study was to investigate the effects of NAC on spinal cord injury in an experimental rat model.A total of 48 adult male wistar albino rats were divided into six groups. Group C included the control rats, group L included the rats that underwent laminectomy, and group T included the rats in which spinal cord trauma was induced by the weight-drop method after laminectomy. Groups M (the methylprednisolone group), N (the NAC group), and MN (the methylprednisolone + NAC group) were the treatment groups. In the fourth group (group M), 30 mg/kg methylprednisolone (MP) was administered as a bolus intraperitoneally (IP), and a standard MP treatmentat a dose of 5.4 mg/kg was applied for 24 h. In the fifth group (group N), only 300 mg/kg NAC was administered as a bolus IP. In the sixth group (group MN), the standard MP treatment and a single 300 mg/kg dose of NAC were administered as a bolus IP. The motor functions of the rats were evaluated on the 1st, 7th, and 14th days using the inclined plane test defined by Rivlin and Tator and the motor scale defined by Gale et al. Spinal cord samples were obtained on the 14th day. The samples were evaluated using pathological and biochemical analysis.In the neuroclinical assessment, no differences were observed between groups T and M in terms of motor improvement. However, statistically significant differences were observed between group T and groups N and MN (p 0.001, p = 0.01, respectively). Statistically significant differences were also seen between group M and groups N and MN on the 1st and 7th days (p 0.017, p 0.01, respectively). Additionally, when groups N and MN were compared with groups T and M,the pathological and biochemical analyses were found to be statistically different (p 0.05, p 0.001, respectively).It was concluded that NAC treatment and the combined NAC + MP treatment may be more useful for healing in rats with experimental spinal cord injury in terms of neuroclinical, pathological, and biochemical results than MP-only therapy.

Jean Schoenen* talks to Alisa Crisp, Assistant Commissioning Editor: Jean Schoenen gained his medical degree in 1972 from Liege University, Belgium. For 2 years he was an International Fogarty Fellow in the departments of Neurology and Neuropathology of the Massachusetts General Hospital, Harvard Medical School (MA, USA) where he obtained certificates in Clinical Neurophysiology and Neuropathology. He is a board-certified neurologist since 1979 and holds doctoral and postdoctoral degrees from Liege University. He was Research Director of the National Fund for Scientific Research (Belgium) and Clinical Professor in Neurology before taking over Full Professorship at Liege University in 1998. He is acting chairman of the Department of Biomedical and Preclinical Sciences at the Faculty of Medicine (Liege University). His research has focused on headache and spinal cord anatomy and pathology. Dr Schoenen leads the Headache and Neuronal Regeneration Research Unit and Headache Clinic at Liege University. He has ...

Spine trauma is a devastating clinical condition that affects many people annually on a worldwide basis. Management of spinal trauma has become much more surgically oriented with advances in stabilization techniques over the past two decades. The degree of injury to the spinal cord dictates the prognosis of the patient in cervical and thoracolumbar trauma. Traumatic spinal cord injury is a major area of socioeconomic burden and, as such, is a burgeoning area of ongoing research interest.

The history of spinal cord injury (SCI) dates back as far as the ancient Egyptians, who described it as an ‘ailment not to be treated’ ( Eltorai, 2003 ). For a long time, victims of SCI saw a bleak future confined to a wheelchair and a lifetime of comorbidities and poor survival rates ( McDonald and Sadowsky, 2002 ). It was not until after World War II that the outlook for such patients began to improve ( Eltorai, 2003 ). The development of an infrastructure for the emergency transportation of injured patients and advances in acute care and rehabilitation practices have dramatically reduced mortality and morbidity ( Talu et al. 2005 ). Therapies to enhance neurological function following SCI have been extensively investigated by the clinical and scientific community. Subsequently, significant insight has been generated into the pathology and pathophysiology of acute spinal cord trauma. It has been hypothesised that the primary mechanical injury to the spinal cord initiates a cascade of vascular, cellular and biochemical events that cause extension of the injury site. Current interventions for the acutely cord-injured patient attempt to minimise this secondary injury and protect the tissue that initially survived the mechanical injury ( Dumont et al, 2001 ; Kwon et al. 2004 ; Li and Yang, 2009 ).

OBJECTIVE: Evaluate the surgical results of axis screw instrumentation. METHODS: Retrospective evaluation of the clinical and radiological data of patients submitted to axis fixation using screws. RESULTS: Seventeen patients were surgically treated. The mean age was 41.8 years (range: 12-73). Spinal cord trauma was the most common cause of instability (8 patients - 47%). Bilateral axis fixation was performed in all cases, except one, with laminar screw (total of 33 axis screws). Seven patients (41.1%) underwent bilateral pars screws; laminar screws were used in six cases and pedicular screws were used in two. In two cases, we performed a hybrid construction (laminar + pars and pedicle + pars). There was no neurological worsening or death, nor complications directly related to use axis screws. CONCLUSION: Axis instrumentation was effective and safe, regardless of the technique used for stabilization. Based on our learnt experience, we proposed an algorithm to choose the best technique for axis screw fixation. OBJETIVO: Avaliar os resultados cirúrgicos da instrumentação com parafusos do áxis. MÉTODOS: Avaliação retrospectiva de dados clínicos e radiológicos de pacientes submetidos à instrumentação com parafusos do áxis. RESULTADOS: Dezessete pacientes foram tratados cirurgicamente. A média de idade foi de 41,8 anos (faixa: 12-73 anos). Trauma na coluna foi a causa mais comum de instabilidade (8 casos - 47%). Fixação bilateral do áxis foi realizada em todos os casos, exceto em um, com parafuso de lâmina (total de 33 parafusos). Em sete pacientes (41,1%), foram usados parafusos de pars; em seis, parafusos de lâmina; e em dois, de pedículos. Em dois casos, foi utilizada uma combinação de técnicas (pars + lâmina e pars + pedículo). Não houve piora neurológica nem complicações diretas em decorrência do uso dos parafusos. CONCLUSÃO: A instrumentação do áxis foi eficaz e segura independentemente da técnica escolhida para estabilização. Com base em nossa experiência, foi proposto um algoritmo para auxílio na escolha da melhor técnica a ser empregada.

Objective: To evaluate the effect of monosialoganglioside (GM-1) in spinal cord trauma patients seen in our service who have not been treated with methylprednisolone. Methods: Thirty patients with acute spinal cord trauma were randomly divided into two groups. In Group 1, patients received 200 mg GM-1 in the initial assessment and thereafter received 100 mg intravenous per day for 30 days and Group 2 (control) received saline. Patients were evaluated periodically (at 6 weeks, 6 months, one year and two years), using a standardized neurological assessment of the American Spinal Injury Association / International Spinal Cord Society. Results: The comparative statistical analysis of motor indices, sensitive indices for pain and touch according to the standardization of ASIA / ISCOS showed that the assessments at 6 weeks, 6 months and 2 years, GM-Group 1 patients had higher rates than the control group regarding sensitivity to pain and touch, with no statistically significant difference from the motor index. Conclusion: The functional assessment showed improvement in the sensitive indices of patients treated with GM1 after post-traumatic spinal cord injury compared to patients who received placebo. Level of Evidence IV, Prospective Case Studies Series.

Pediatric spinal trauma is relatively rare with roughly 5% of injuries occurring in this group. Cervical spinal trauma is most common in the pediatric population, followed by thoracic and lumbar injuries. The biomechanics of the evolving pediatric anatomy alter the injury characteristics and radiographic interpretation of pediatric spinal trauma patients. Systematic assessment paradigms are necessary in the evaluation and treatment of pediatric spinal cord trauma patients. Common treatment modalities for this subgroup of patients include halo fixation, bracing, and surgical instrumentation. While the surgical management options for pediatric spinal injuries have improved, the anatomical considerations associated with the size and growth potential of pediatric patients provide room for improvement of these modalities.