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Mavridis T, Mavridi A, Karampela E, Galanos A, Gkiokas G, Iacovidou N, Xanthos T. Sovateltide (ILR-1620) Improves Motor Function and Reduces Hyperalgesia in a Rat Model of Spinal Cord Injury. Neurocrit Care 2024:10.1007/s12028-024-01950-2. [PMID: 38443708 DOI: 10.1007/s12028-024-01950-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/26/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Spinal cord injury (SCI) presents a major global health challenge, with rising incidence rates and substantial disability. Although progress has been made in understanding SCI's pathophysiology and early management, there is still a lack of effective treatments to mitigate long-term consequences. This study investigates the potential of sovateltide, a selective endothelin B receptor agonist, in improving clinical outcomes in an acute SCI rat model. METHODS Thirty male Sprague-Dawley rats underwent sham surgery (group A) or SCI and treated with vehicle (group B) or sovateltide (group C). Clinical tests, including Basso, Beattie, and Bresnahan scoring, inclined plane, and allodynia testing with von Frey hair, were performed at various time points. Statistical analyses assessed treatment effects. RESULTS Sovateltide administration significantly improved motor function, reducing neurological deficits and enhancing locomotor recovery compared with vehicle-treated rats, starting from day 7 post injury. Additionally, the allodynic threshold improved, suggesting antinociceptive properties. Notably, the sovateltide group demonstrated sustained recovery, and even reached preinjury performance levels, whereas the vehicle group plateaued. CONCLUSIONS This study suggests that sovateltide may offer neuroprotective effects, enhancing neurogenesis and angiogenesis. Furthermore, it may possess anti-inflammatory and antinociceptive properties. Future clinical trials are needed to validate these findings, but sovateltide shows promise as a potential therapeutic strategy to improve functional outcomes in SCI. Sovateltide, an endothelin B receptor agonist, exhibits neuroprotective properties, enhancing motor recovery and ameliorating hyperalgesia in a rat SCI model. These findings could pave the way for innovative pharmacological interventions for SCI in clinical settings.
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Affiliation(s)
- Theodoros Mavridis
- First Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
- Department of Neurology, Tallaght University Hospital (TUH)/The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Dublin, Ireland.
| | - Artemis Mavridi
- First Department of Pediatrics, Medical School, Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Antonis Galanos
- Laboratory for Research of the Musculoskeletal System, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George Gkiokas
- Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicoletta Iacovidou
- Department of Neonatology, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Xanthos
- School of Health and Caring Sciences, University of West Attica, Athens, Greece
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Martin AR, Aleksanderek I, Fehlings MG. Diagnosis and Acute Management of Spinal Cord Injury: Current Best Practices and Emerging Therapies. CURRENT TRAUMA REPORTS 2015. [DOI: 10.1007/s40719-015-0020-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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3
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Walters BC, Hadley MN, Hurlbert RJ, Aarabi B, Dhall SS, Gelb DE, Harrigan MR, Rozelle CJ, Ryken TC, Theodore N. Guidelines for the management of acute cervical spine and spinal cord injuries: 2013 update. Neurosurgery 2014; 60:82-91. [PMID: 23839357 DOI: 10.1227/01.neu.0000430319.32247.7f] [Citation(s) in RCA: 295] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Sadek AR, Eynon CA. The role of neurosciences intensive care in trauma and neurosurgical conditions. Br J Hosp Med (Lond) 2014; 74:552-7. [PMID: 24105307 DOI: 10.12968/hmed.2013.74.10.552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The creation of neurosciences intensive care units was born out of the awareness that a group of neurological and neurosurgical patients required specialized intensive medical and nursing care. This first of two articles describes the role of neurosciences intensive care in the management of trauma and neurosurgical conditions.
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Affiliation(s)
- Ahmed-Ramadan Sadek
- Walport Academic Clinical Fellow in Neurosurgery and Jason Brice Fellow in Neurosurgical Research
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Taneja A, Berry CA, Rao RD. Initial Management of the Patient With Cervical Spine Injury. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.semss.2012.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Wilson JR, Arnold PM, Singh A, Kalsi-Ryan S, Fehlings MG. Clinical prediction model for acute inpatient complications after traumatic cervical spinal cord injury: a subanalysis from the Surgical Timing in Acute Spinal Cord Injury Study. J Neurosurg Spine 2013; 17:46-51. [PMID: 22985370 DOI: 10.3171/2012.4.aospine1246] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT While the majority of existing reports focus on complications sustained during the chronic stages after traumatic spinal cord injury (SCI), the objective in the current study was to characterize and quantify acute inpatient complications. In addition, the authors sought to create a prediction model using clinical variables documented at hospital admission to predict acute complication development. METHODS Analyses were based on data from the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS) data registry, which contains prospective information on adult patients with cervical SCIs who were enrolled at 6 North American centers over a 7-year period. All patients who underwent a standardized American Spinal Injury Association (ASIA) neurological examination within 24 hours of injury and whose follow-up information was available at the acute hospital discharge were included in the study. For purposes of classification, complications were divided into 5 major categories: 1) cardiopulmonary, 2) surgical, 3) thrombotic, 4) infectious, and 5) decubitus ulcer development. Univariate statistical analyses were performed to determine the relationship between complication occurrence and individual demographic, injury, and treatment variables. Multivariate logistic regression was subsequently performed to create a complication prediction model. Model discrimination was judged according to the area under the receiver operating characteristic curve. RESULTS Complete complication information was available for 411 patients at the acute care discharge. One hundred sixty patients (38.9%) experienced 240 complications. The mean age among those who experienced at least one complication was 45.9 years, as compared with 43.5 years among those who did not have a complication (p = 0.18). In the univariate analysis, patients with complications were less likely to receive steroids at admission (p = 0.01), had a greater severity of neurological injury as indicated by the ASIA Impairment Scale (AIS) grade at presentation (p < 0.01), and a higher frequency of significant comorbidity (p = 0.04). In a multivariate logistic regression model, a severe initial AIS grade (p < 0.01), a high-energy injury mechanism (p = 0.07), an older age (p = 0.05), the absence of steroid administration (p = 0.02), and the presence of comorbid illness (p = 0.02) were associated with a greater likelihood of complication development during the period of acute hospitalization. The area under the curve value for the full model was 0.75, indicating acceptable predictive discrimination. CONCLUSIONS These results will help clinicians to identify patients with cervical SCIs at greatest risk for complication development and thus allowing for the institution of aggressive complication prevention measures.
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Affiliation(s)
- Jefferson R Wilson
- Department of Surgery, Division of Neurosurgery, University of Toronto, Ontario, Canada
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Wilson JR, Forgione N, Fehlings MG. Emerging therapies for acute traumatic spinal cord injury. CMAJ 2012; 185:485-92. [PMID: 23228995 DOI: 10.1503/cmaj.121206] [Citation(s) in RCA: 133] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Jefferson R Wilson
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto, Ont
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Furlan JC, Singh J, Hsieh J, Fehlings MG. Methodology of systematic reviews and recommendations. J Neurotrauma 2011; 28:1335-9. [PMID: 20146555 PMCID: PMC3143415 DOI: 10.1089/neu.2009.1146] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Although research in the field of spinal cord injury (SCI) is a relatively new endeavor, a remarkable number of papers focused on this subspecialty have been published in a broad variety of journals over the last two decades. A multidisciplinary group of experts, including clinical epidemiologists, neurosurgical and orthopedic spine surgeons, basic scientists, rehabilitation specialists, intensivists, and allied health professionals (nursing and physical therapy) was assembled through the Spinal Cord Injury Solutions Network to summarize the existing literature focusing on 12 key topics related to acute traumatic SCI, which have not been recently reviewed. The objective was to develop evidence-based recommendations to help translate current science into clinical practice and to identify new directions for research. For each topic one to three specific questions were formulated by consensus through the expert panel. A systematic review of the literature was performed to determine the current evidence for the specific questions. A primary literature search was performed using MEDLINE, CINAHL, EMBASE, and Cochrane databases. A secondary search strategy incorporated additional articles referenced in significant publications (i.e., meta-analysis, systematic and nonsystematic review articles). Two reviewers independently reviewed the titles and abstracts yielded by this comprehensive search and subsequently selected articles based on the predetermined inclusion and inclusion criteria. Data were extracted for population into evidentiary tables. Selected articles were rated for level of evidence and methodological quality, information that was also included in evidentiary tables. Disagreements were resolved by a third reviewer or consensus-based discussion. Based on the evidence compiled, answers to the targeted questions were formulated and recommendations generated by consensus-based discussion and anonymized voting using Delphi methodology. A level of consensus of 80% or higher was considered to represent strong agreement.
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Affiliation(s)
- Julio C. Furlan
- Division of Genetics and Development, Toronto Western Research Institute, University Health Network, Ontario, Canada
- Spinal Program, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Ontario, Canada
| | - Jeffrey Singh
- Interdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Ontario, Canada
- Ornge Transport Medicine, Toronto, Ontario, Canada
| | - Jane Hsieh
- Aging, Rehabiliation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada
| | - Michael G. Fehlings
- Division of Genetics and Development, Toronto Western Research Institute, University Health Network, Ontario, Canada
- Spinal Program, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Ontario, Canada
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
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Issaivanan M, Nhlane NM, Rizvi F, Shukla M, Baldauf MC. Brown-Séquard-plus syndrome because of penetrating trauma in children. Pediatr Neurol 2010; 43:57-60. [PMID: 20682206 DOI: 10.1016/j.pediatrneurol.2010.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Revised: 08/25/2008] [Accepted: 03/22/2010] [Indexed: 12/30/2022]
Abstract
Brown-Séquard syndrome is an uncommon condition involving incomplete spinal cord injury, with ipsilateral motor and proprioception loss, contralateral pain, and decreased temperature. Brown-Séquard-plus syndrome is associated with additional neurologic findings involving the eyes, bowel, or bladder. We describe an adolescent with Brown-Séquard-plus syndrome attributable to a stab injury. Our patient's clinical features of spinal and neurogenic shock overlapped at presentation. He was managed with high-dose steroids, along with intense physiotherapy and rehabilitation, resulting in good neurologic recovery. Appropriate medical (and surgical, when indicated) management usually results in good to complete recovery of neurologic function, depending on the level and grade of injury. With the increasing incidence of gunshot wounds and stab injuries in children, pediatricians, including pediatric neurologists and emergency physicians, are more likely to encounter these types of spinal cord injuries in children.
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Affiliation(s)
- Magimairajan Issaivanan
- Department of Pediatrics, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
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Abstract
PURPOSE OF REVIEW The present review focuses on similarities and discrepancies in the management of emergent and elective unstable cervical spine (C-spine) patients. RECENT FINDINGS During mobilization, lifting is superior to rolling in limiting spine movements. Before prone position surgery, the transfer of the patient on a rotating table is preferable to rolling. In trauma patients, helical computed tomography (CT) with sagittal reconstruction is the first choice for clearing the C-spine. In those patients, airway compromise may be related to hidden cervical edema or hematoma. Several devices can be of help in performing safe tracheal intubation in patients with limited neck movements, but awake fiberoptic intubation remains the safest procedure. The muscle relaxant antagonist sugammadex can improve safety for rapid sequence induction. It can rapidly reverse profound steroid-based neuromuscular blockade and allows avoidance of succinylcholine in this indication. Propofol anesthesia better prevents coughing upon emergence than inhaled anesthesia. Neuroprotection in cord-damaged patients is disappointing, and the controversy on the efficacy of high-dose methylprednisolone is not closed. Nevertheless, maintenance of homeostasis remains the cornerstone of neuroprotection. SUMMARY Subtle details differentiate the management of emergent and elective unstable C-spine patients. In both situations, the presence or the absence of a neurological insult governs the therapeutic strategy.
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Furlan JC, Fehlings MG. Cardiovascular complications after acute spinal cord injury: pathophysiology, diagnosis, and management. Neurosurg Focus 2009; 25:E13. [PMID: 18980473 DOI: 10.3171/foc.2008.25.11.e13] [Citation(s) in RCA: 174] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Cardiovascular complications in the acute stage following traumatic spinal cord injury (SCI) require prompt medical attention to avoid neurological compromise, morbidity, and death. In this review, the authors summarize the neural regulation of the cardiovascular system as well as the pathophysiology, diagnosis, and management of major cardiovascular complications that can occur following acute (up to 30 days) traumatic SCI. Hypotension (both supine and orthostatic), autonomic dysreflexia, and cardiac arrhythmias (including persistent bradycardia) are attributed to the loss of supraspinal control of the sympathetic nervous system that commonly occurs in patients with severe spinal cord lesions at T-6 or higher. Current evidence-based guidelines recommend: 1) monitoring of cardiac and hemodynamic parameters in the acute phase of SCI; 2) maintenance of a minimum mean arterial blood pressure of 85 mm Hg during the hyperacute phase (1 week after SCI); 3) timely detection and appropriate treatment of neurogenic shock and cardiac arrhythmias; and 4) immediate and adequate treatment of episodes of acute autonomic dysreflexia. In addition to these forms of cardiovascular dysfunction, individuals with acute SCIs are at high risk for deep venous thrombosis (DVT) and pulmonary embolism due to loss of mobility and, potentially, altered fibrinolytic activity, abnormal platelet function, and impaired circadian variations of hemostatic and fibrinolytic parameters. Current evidence supports a recommendation for thromboprophylaxis using mechanical methods and anticoagulants during the acute stage up to 3 months following SCI, depending on the severity and level of injury. Low-molecular-weight heparin is the first choice for anticoagulant prophylaxis in patients with acute SCI. Although there is insufficient evidence to recommend (or refute) the use of screening tests for DVT in asymptomatic adults with acute SCI, this strategy may detect asymptomatic DVT in at least 9.4% of individuals who undergo thromboprophylaxis using lowmolecular- weight heparin. Indications and treatment of DVT and acute pulmonary embolism are well established and are summarized in this review. Recognition of cardiovascular complications after acute SCI is essential to minimize adverse outcomes and to optimize recovery.
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Affiliation(s)
- Julio C Furlan
- Division of Genetics and Development, Toronto Western Research Institute, University Health Network, Ontario, Canada
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12
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Karlsson AK. Autonomic dysfunction in spinal cord injury: clinical presentation of symptoms and signs. PROGRESS IN BRAIN RESEARCH 2006; 152:1-8. [PMID: 16198689 DOI: 10.1016/s0079-6123(05)52034-x] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Spinal cord injury and especially cervical spinal cord injury implies serious disturbances in autonomic nervous system function. The clinical effects of these disturbances are striking. In the acute phase, the autonomic imbalance and its effect on cardiovascular, respiratory system and temperature regulation may be life threatening. Serious complications such as over-hydration with the risk of pulmonary edema or hyponatremia are seen. The cord-injured person suffers from autonomic nervous system dysfunction also affecting bladder and bowel control, renal and sexual function. Paralytic ileus may cause vomiting and aspiration, which in turn interferes with respiratory function in those with cervical spinal cord injury. The cord-injured person is at risk to develop pressure sores from the moment of the accident. Two to three months post-injury the cord-injured person with a lesion level above the fifth thoracic segment may develop autonomic dysreflexia, characterised by sympathetically mediated vasoconstriction in muscular, skin, renal and presumably gastrointestinal vascular beds induced by an afferent peripheral stimulation below lesion level. The reaction might cause cerebrovascular complications and has effects on metabolism. Some of the autonomic disturbances are transient and a new balance is reached months post-injury, while others persist for life.
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Affiliation(s)
- Ann-Katrin Karlsson
- Spinal Injuries Unit, Sahlgrenska University Hospital, Institute of Clinical Neuroscience, Sahlgrenska Academy, S 413 45 Goteborg, Sweden. ann-katrin@
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Doblar DD, Schumacher SD. Spontaneous acute thoracic epidural hematoma causing paraplegia in a patient with severe preeclampsia in early labor. Int J Obstet Anesth 2005; 14:256-60. [PMID: 15935638 DOI: 10.1016/j.ijoa.2004.09.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2004] [Revised: 08/01/2004] [Accepted: 09/01/2004] [Indexed: 11/29/2022]
Abstract
This is a case of acute spontaneous thoracic epidural hematoma in a laboring patient at term who presented with severe preeclampsia and acute spinal cord compression, paraplegia, and sensory loss below T8. In early labor, at home, the patient experienced sudden lumbar back pain that progressed to mid-scapular pain leading to paraplegia and T8 sensory loss within one hour of onset of pain. Her symptoms were caused by a spontaneous thoracic epidural hematoma. Upon arrival at the first hospital, the correct presumptive diagnosis was made in the emergency room, magnesium sulfate was administered, and the patient was transferred to our medical center. Her hypertension was not treated despite severe preeclampsia in order to maintain spinal cord perfusion pressure. Following cesarean section under general anesthesia, thoracic laminectomy was performed and an epidural hematoma compressing the spinal cord to 2-3 mm was evacuated 13 h after the onset of symptoms. After approximately three months of paraplegia, five months with quad-walker and cane use, the patient can now walk with a cane or other minimal support but has remaining bowel and bladder problems. The conflicting anesthetic management objectives of severe preeclampsia and acute paraplegia secondary to spinal epidural hematoma required compromise in the management of her preeclampsia in order to preserve spinal cord perfusion.
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Affiliation(s)
- D D Doblar
- Department of Anesthesiology, The University of Alabama, Birmingham, Alabama 35249-6810, USA.
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O'Keeffe T, Goldman RK, Mayberry JC, Rehm CG, Hart RA. Tracheostomy after anterior cervical spine fixation. ACTA ACUST UNITED AC 2005; 57:855-60. [PMID: 15514542 DOI: 10.1097/01.ta.0000083006.48501.b2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with cervical spine injury may require both anterior cervical spine fusion and tracheostomy, particularly in the setting of associated cervical spinal cord injury (SCI). Despite the close proximity of the two surgical incisions, we postulated that tracheostomy could be safely performed after anterior spine fixation. In addition, we postulated that the severity of motor deficits in patients with cervical spine injury would correlate with the need for tracheostomy. METHODS A retrospective review was undertaken of all adult trauma patients diagnosed with cervical spine fractures or cervical SCI admitted between June 1996 and June 2001 at our university Level I trauma center. Demographic data, severity of neurologic injury based on the classification of the American Spinal Injury Association (ASIA), complications, and use and type of tracheostomy were collected. In the subgroup of patients with unstable cervical spine injury that underwent anterior stabilization and tracheostomy, data regarding timing and technique of these procedures and wound outcomes were also collected. Categorical data were analyzed using chi analysis using Yates correction when appropriate, with p <0.05 considered significant. RESULTS During this time period, 275 adult survivors were diagnosed with cervical spinal cord or bony injury. Forty-five percent of patients with SCI (27 of 60) and 14% of patients without SCI (30 of 215) underwent tracheostomy (p <0.001). Moreover, on the basis of the ASIA classification system, 76% of ASIA A and B patients, 38% of ASIA C patients, 23% of ASIA D patients, and 14% of ASIA E patients were treated with tracheostomy (p <0.001). In the subgroup that underwent both anterior spine fixation and tracheostomy (n=17), the median time interval from spine fixation to airway placement was 7 days (interquartile range, 6-10 days), with 71% of these tracheostomies performed percutaneously. No patient developed a wound infection or nonunion as a consequence of tracheostomy placement, and there were no deaths because of complications of either procedure. CONCLUSION These data support the safety of tracheostomy insertion 6 to 10 days after anterior cervical spine fixation, particularly in the presence of cervical SCI. The presence of severe motor neurologic deficits was strongly associated with the use of tracheostomy in patients with cervical spine injury. Percutaneous tracheostomy, which is our technique of choice, may be advantageous in this setting by virtue of creating only a small wound. The optimal timing and use of tracheostomy in patients with cervical spine injury requires further study.
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Affiliation(s)
- Terence O'Keeffe
- Department of Surgery, Oregon Health & Science University, Portland, Oregon 97239, USA
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Krassioukov AV, Furlan JC, Fehlings MG. Autonomic dysreflexia in acute spinal cord injury: an under-recognized clinical entity. J Neurotrauma 2003; 20:707-16. [PMID: 12965050 DOI: 10.1089/089771503767869944] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
While autonomic dysreflexia (AD) is well recognized in the chronic stage of spinal cord injury (SCI) this potentially life-threatening complication has been only rarely documented in the acute phase (1 month) after SCI. Based on our clinical experience we hypothesized that AD is under-recognized in the acute phase of SCI. This study was undertaken to determine the incidence and clinical associations of early AD in our center. We reviewed the charts of patients with acute traumatic SCI admitted to the Toronto Western Hospital Spinal Program between 1998 and 2000. Among 58 patients with acute traumatic SCI (15F, 43M; ages 17-89 years, mean of 55.4), all three individuals who developed evidence of early AD had complete cervical tetraplegia (1F, 2M; ages 31-42 years, mean of 38.3). The incidence of early AD was 5.2% (3 of 58), whereas the adjusted incidence for the population at risk (SCI at T6 or above) was 5.7% (3 of 53). A significant number of patients in this series (87.9%, or 51 of 58) had a cervical SCI. While the mean resting systolic arterial blood pressure among these three individuals was 105.7+/-3 mm Hg, the mean systolic blood pressure at the time of early AD was 173.3+/-14.8 mm Hg (increase in systolic blood pressure over baseline ranged from 35.5% to 95%). The earliest episode of AD occurred on the 4(th) post-injury day. The trigger mechanisms for AD were somatic pain, fecal impaction, and abdominal distention. Although numerous reports emphasize AD as a potential complication of chronic SCI, our study demonstrates that AD occurs in 5.7% of patients with acute SCI above T6. Patients with severe cervical SCI are particularly susceptible to the early onset of AD. Clinicians need to be aware and highly vigilant of the potential development of AD in the acute phase of SCI.
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Affiliation(s)
- Andrei V Krassioukov
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
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Peter Vellman W, Hawkes AP, Lammertse DP. Administration of corticosteroids for acute spinal cord injury: the current practice of trauma medical directors and emergency medical system physician advisors. Spine (Phila Pa 1976) 2003; 28:941-7; discussion 947. [PMID: 12942012 DOI: 10.1097/01.brs.0000058708.46933.3d] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE In 1997, the results from the Third National Acute Spinal Cord Injury Study (NASCIS 3) were published. We undertook the present study to determine the treatment protocols for patients with spinal cord injuries in Colorado and assess whether there were any barriers to the administration of corticosteroids. STUDY DESIGN Cross-sectional. METHODS In May 1999, surveys were mailed to every trauma facility medical director and emergency medical system physician advisor in the state. Physicians were asked to provide information about their facilities' or agencies' current practice(s) for administering steroids to patients with spinal cord injuries. They were also asked about their opinion on whether the data on corticosteroid treatment for spinal cord injury support its use. RESULTS Ninety-eight percent (39 out of 41) of the medical directors who responded and treat patients with spinal cord injuries said that their facilities do administer steroids to those patients. Fourteen percent reported following the NASCIS 3 protocol; 75%, the NASCIS 2 protocol. About half of the medical directors were either uncertain or did not believe that the data regarding the corticosteroid treatment for spinal cord injury supported its use. The majority of physician advisors responded that they do not authorize the administration of corticosteroids to patients with spinal cord injuries in the field, primarily because of short transport times. CONCLUSIONS Our study demonstrated relatively poor compliance with the NASCIS 3 protocol, but good compliance with the NASCIS 2 protocol. There was skepticism about the efficacy of corticosteroid treatment among some Colorado physicians that treat patients with spinal cord injuries acutely; however, this does not completely explain the findings.
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Affiliation(s)
- W Peter Vellman
- Emergency Department, St. Anthony Central Hospital, Denver, CO 80204, USA.
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