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Ahmad M, Ghaly P, Iliopoulos J. Lumbar drain management protocol for use in complex aortic aneurysm repairs. ANZ J Surg 2021; 91:1652-1654. [PMID: 34506064 DOI: 10.1111/ans.16697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/30/2021] [Accepted: 02/11/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Mehtab Ahmad
- Liverpool Hospital Vascular Unit, South West Sydney Local Health District, Sydney, New South Wales, Australia
| | - Paul Ghaly
- Liverpool Hospital Vascular Unit, South West Sydney Local Health District, Sydney, New South Wales, Australia
| | - Jim Iliopoulos
- Liverpool Hospital Vascular Unit, South West Sydney Local Health District, Sydney, New South Wales, Australia
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2
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Abstract
The unique anatomy and flexibility of the cervical spine predispose it to a risk of injury. Trauma to the cervical spine encompasses a wide range of injuries from minor muscular strains to life-threatening fracture-dislocations associated with spinal cord lesions. Initial assessment and management should follow the Advanced Trauma Life Support (ATLS) protocols with adequate protection of the cervical spine through triple immobilisation to prevent any unnecessary movement, which can make the patient susceptible to further neurological injuries. Although the presence of cervical spine injury is very often overt, reliance on clinical examination alone is sometimes not sufficient and potentially requires further imaging. Clinical decision rules such as the Canadian C-Spine Rule are frequently used to risk-stratify patients needing radiography. The level of cervical spine instability and knowledge of their unique classification systems is of paramount importance and assists in the decision-making process to guide definitive management. In this review, we also propose an algorithm to aid the initial management of a patient with suspected cervical spine injury in the emergency department.
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Affiliation(s)
| | - Komal Moqeem
- Emergency Department, Royal Surrey County Hospital, Guildford, GBR
| | - Mujeeb U Rohilla
- Trauma and Orthopaedics, Milton Keynes University Hospital, Milton Keynes, GBR
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3
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Singh V, Thanvi S. Arrow-Shot Injury to Pediatric Spinal Cord. INDIAN JOURNAL OF NEUROTRAUMA 2021. [DOI: 10.1055/s-0041-1724142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractPenetrating spinal cord injuries (PSCI) in cervical region are extremely rare in pediatric population. Most injuries in pediatric population are accidental due to gunshot or a stab injury with a sharp or pointed object. Gun shots may result into a severe wound which is usually fatal and may result in death, quadriplegia, or serious long-term disability. Stab injuries are less severe and may result in neurological sequalae. In this paper, an unusual case of pediatric arrow shot partial cervical cord injury is reported which was managed by aggressive neurosurgical management. The arrow lodged in the cervical cord was very near to the vertebral artery leading to parapariesis which recovered well without any complications. Diagnostic imaging at admission included radiographs, computed tomography (CT), and CT angiography of the cervical region. The patient underwent early surgical intervention with removal of foreign body from the cord and subsequent dural suturing.
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Affiliation(s)
- Vijayveer Singh
- Department of Neurosurgery, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
| | - Sharad Thanvi
- Department of Neurosurgery, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
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Sandean D. Management of acute spinal cord injury: A summary of the evidence pertaining to the acute management, operative and non-operative management. World J Orthop 2020; 11:573-583. [PMID: 33362993 PMCID: PMC7745491 DOI: 10.5312/wjo.v11.i12.573] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/28/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
Acute traumatic spinal cord injury is often a lifechanging and devastating event with considerable mortality and morbidity. Over half a million people suffer from traumatic spinal cord injury annually with the majority resulting from road traffic accidents or falls. The Individual, societal and economic costs are enormous. Initial recognition and treatment of acute traumatic spinal cord injury are crucial to limit secondary injury to the spinal cord and to provide patients with the best chance of some functional recovery. This article is an overview of the management of the acute traumatic spinal cord injury patient presenting to the emergency department. We review the initial assessment, criteria for imaging and clearing the spine, and evaluate the literature to determine the optimum timing of surgery and the role of non-surgical treatment in patients presenting with acute spinal cord injury.
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Affiliation(s)
- Darren Sandean
- Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, United Kingdom
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5
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Liau LL, Looi QH, Chia WC, Subramaniam T, Ng MH, Law JX. Treatment of spinal cord injury with mesenchymal stem cells. Cell Biosci 2020; 10:112. [PMID: 32983406 PMCID: PMC7510077 DOI: 10.1186/s13578-020-00475-3] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/15/2020] [Indexed: 12/16/2022] Open
Abstract
Background Spinal cord injury (SCI) is the damage to the spinal cord that can lead to temporary or permanent loss of function due to injury to the nerve. The SCI patients are often associated with poor quality of life. Results This review discusses the current status of mesenchymal stem cell (MSC) therapy for SCI, criteria to considering for the application of MSC therapy and novel biological therapies that can be applied together with MSCs to enhance its efficacy. Bone marrow-derived MSCs (BMSCs), umbilical cord-derived MSCs (UC-MSCs) and adipose tissue-derived MSCs (ADSCs) have been trialed for the treatment of SCI. Application of MSCs may minimize secondary injury to the spinal cord and protect the neural elements that survived the initial mechanical insult by suppressing the inflammation. Additionally, MSCs have been shown to differentiate into neuron-like cells and stimulate neural stem cell proliferation to rebuild the damaged nerve tissue. Conclusion These characteristics are crucial for the restoration of spinal cord function upon SCI as damaged cord has limited regenerative capacity and it is also something that cannot be achieved by pharmacological and physiotherapy interventions. New biological therapies including stem cell secretome therapy, immunotherapy and scaffolds can be combined with MSC therapy to enhance its therapeutic effects.
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Affiliation(s)
- Ling Ling Liau
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, 56000 Kuala Lumpur, Malaysia
| | - Qi Hao Looi
- Ming Medical Services Sdn. Bhd., Pusat Perdagangan Dana 1, 47301 Petaling Jaya, Selangor Malaysia
| | - Wui Chuen Chia
- Ming Medical Services Sdn. Bhd., Pusat Perdagangan Dana 1, 47301 Petaling Jaya, Selangor Malaysia
| | - Thayaalini Subramaniam
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, JalanYaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Min Hwei Ng
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, JalanYaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Jia Xian Law
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, JalanYaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
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Badenhorst M, Verhagen E, Lambert M, van Mechelen W, Brown J. When This Happens, You Want the Best Care: Players' Experiences of Barriers and Facilitators of the Immediate Management of Rugby-Related Acute Spinal Cord Injury. QUALITATIVE HEALTH RESEARCH 2019; 29:1862-1876. [PMID: 30864491 DOI: 10.1177/1049732319834930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Most contact sports, including rugby union, carry a risk of injury. Although acute spinal cord injuries (ASCIs) in rugby are rare, the consequences of such injuries are far-reaching. Optimal management of these injuries is challenging, and a detailed understanding of the different barriers and facilitators to optimal care is needed. In this study, we aimed to describe the perception of players, regarding factors related to the optimal immediate management of a catastrophic injury in a developing country with socioeconomic and health care inequities. The most frequently reported barriers were transportation delays after injury and admission to appropriate medical facilities. Other barriers included inadequate equipment, the quality of first aid care, and barriers within the acute hospital setting. Barriers were more prevalent in rural and lower socioeconomic areas. These findings are relevant for all rugby stakeholders and may help shape education, awareness, and future policy around the immediate management of ASCIs.
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Affiliation(s)
- Marelise Badenhorst
- University of Cape Town, Cape Town, South Africa
- Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Evert Verhagen
- University of Cape Town, Cape Town, South Africa
- Amsterdam UMC, VU University, Amsterdam, The Netherlands
- Federation University Australia, Ballarat, Victoria, Australia
| | - Mike Lambert
- University of Cape Town, Cape Town, South Africa
- Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Willem van Mechelen
- University of Cape Town, Cape Town, South Africa
- Amsterdam UMC, VU University, Amsterdam, The Netherlands
- The University of Queensland, Brisbane, Queensland, Australia
- University College Dublin, Dublin, Ireland
| | - James Brown
- Stellenbosch University, Stellenbosch, South Africa
- International Olympic Committee Research Centre, Cape Town, South Africa
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Fehlings MG, Kim KD, Aarabi B, Rizzo M, Bond LM, McKerracher L, Vaccaro AR, Okonkwo DO. Rho Inhibitor VX-210 in Acute Traumatic Subaxial Cervical Spinal Cord Injury: Design of the SPinal Cord Injury Rho INhibition InvestiGation (SPRING) Clinical Trial. J Neurotrauma 2018; 35:1049-1056. [PMID: 29316845 PMCID: PMC5908415 DOI: 10.1089/neu.2017.5434] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Traumatic spinal cord injury (SCI) is associated with a lifetime of disability stemming from loss of motor, sensory, and autonomic functions; these losses, along with increased comorbid sequelae, negatively impact health outcomes and quality of life. Early decompression surgery post-SCI can enhance patient outcomes, but does not directly facilitate neural repair and regeneration. Currently, there are no U.S. Food and Drug Administration-approved pharmacological therapies to augment motor function and functional recovery in individuals with traumatic SCI. After an SCI, the enzyme, Rho, is activated by growth-inhibitory factors and regulates events that culminate in collapse of the neuronal growth cone, failure of axonal regeneration, and, ultimately, failure of motor and functional recovery. Inhibition of Rho activation is a potential treatment for injuries such as traumatic SCI. VX-210, an investigational agent, inhibits Rho. When administered extradurally after decompression (corpectomy or laminectomy) and stabilization surgery in a phase 1/2a study, VX-210 was well tolerated. Here, we describe the design of the SPRING trial, a multicenter, phase 2b/3, randomized, double-blind, placebo-controlled clinical trial to evaluate the efficacy and safety of VX-210 (NCT02669849). A subset of patients with acute traumatic cervical SCI is currently being enrolled in the United States and Canada. Medical, neurological, and functional changes are evaluated at 6 weeks and at 3, 6, and 12 months after VX-210 administration. Efficacy will be assessed by the primary outcome measure, change in upper extremity motor score at 6 months post-treatment, and by secondary outcomes that include question-based and task-based evaluations of functional recovery.
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Affiliation(s)
- Michael G Fehlings
- 1 Division of Neurosurgery and Spine Program, University of Toronto , Toronto, Ontario, Canada
| | - Kee D Kim
- 2 Department of Neurological Surgery, University of California Davis School of Medicine , Sacramento, California
| | - Bizhan Aarabi
- 3 Department of Neurosurgery, University of Maryland School of Medicine , Baltimore, Maryland
| | - Marco Rizzo
- 4 Vertex Pharmaceuticals Incorporated , Boston, Massachusetts
| | - Lisa M Bond
- 5 BioAxone BioSciences, Inc , Cambridge, Massachusetts
| | | | - Alexander R Vaccaro
- 6 Department of Orthopaedic Surgery, Sidney Kimmel Medical Center at Thomas Jefferson University , Philadelphia, Pennsylvania
| | - David O Okonkwo
- 7 Department of Neurological Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
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9
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Long B, Koyfman A. Clinical Mimics: An Emergency Medicine–Focused Review of Sepsis Mimics. J Emerg Med 2017; 52:34-42. [DOI: 10.1016/j.jemermed.2016.07.102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 07/21/2016] [Indexed: 10/20/2022]
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10
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Taylor MP, Wrenn P, O'Donnell AD. Presentation of neurogenic shock within the emergency department. Emerg Med J 2016; 34:157-162. [PMID: 27697845 DOI: 10.1136/emermed-2016-205780] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 07/20/2016] [Accepted: 09/15/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Injury to the spinal cord can result in loss of sympathetic innervation causing a drop in BP and HR, this condition is known as neurogenic shock. There is debate among the literature on how and when neurogenic shock presents and what values of HR and BP should be used to define it. Previous studies do not take into account multiple prehospital and emergency department recordings. OBJECTIVE To improve understanding of how neurogenic shock presents in humans, allowing better identification and treatment. METHODS The Trauma Audit and Research Network database for an adult major trauma centre was used to isolate patients with a spinal cord injury. Qualifying patients had all available BPs and HRs collated into a database. Patients with neurogenic shock were isolated, allowing data analysis. RESULTS Out of 3069 trauma patients, 33 met the inclusion criteria, of which 15 experienced neurogenic shock. 87% of the patients who had neurogenic shock experienced it within 2 hours of injury. Neurogenic shock below the T6 level was less common (p=0.009); however, there were still four cases in the cohort. More patients with complete spinal cord injury had neurogenic shock (p=0.039). CONCLUSIONS Neurogenic shock is variable and unpredictable. It can present in the prehospital environment and without warning in a patient with previously normal vital signs. The medical team should be aware of it in all patients with spinal cord injury regardless of injury level.
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Affiliation(s)
- Matthew Pritam Taylor
- Medical Teaching Centre, Warwick Medical School, University of Warwick, Coventry, UK
| | - Paul Wrenn
- Emergency Department, University Hospital Coventry and Warwickshire, Coventry, UK
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