Presentation
Cushing performed laminectomies within 24 hours on patients with immediate presentations-both complete and incomplete spinal cord lesions. [ncbi.nlm.nih.gov]
Initially, this may present as spinal shock, which is an acute physiological loss or depression of spinal cord function. [amboss.com]
Presentations of SCI have a bimodal distribution. Cases related to trauma in younger adults often involve higher velocity injury in a healthy spine. [trauma.reach.vic.gov.au]
We found a median delay between presentation and diagnosis was 3.7 days, and median delay between presentation and treatment of 5.6 days. [bmcpediatr.biomedcentral.com]
Entire Body System
- Pain
[…] as well as for patients with severe pain and inability to function who have not gotten better after at least three to six months of non-surgical treatment. [ana-neurosurgery.com]
but patients who are distracted by other painful injuries (eg, long bone fractures) or whose level of consciousness is altered by intoxicants or head injury may not complain of pain. 14. [slideshare.net]
The severity of initial neck pain intensity is a predictor of long term pain severity.27,28 This may reflect the variable success of the wide range of therapies used to manage post-traumatic neck pain including physiotherapy, exercise, early mobilisation [racgp.org.au]
All four patients demonstrated spontaneous relief of pain within 2 weeks after injury. The pain was modified by transcutaneous stimulation in one case and by l-dopa in another case. [ncbi.nlm.nih.gov]
More severe injuries can damage the spinal cord or nerve roots to cause paralysis or regional pain and weakness. [mdmercy.com]
- Falling
Over the past several decades, the mean age of the spinal cord-injured patient has increased which is attributed to a substantially greater proportion of injuries related to falls in the elderly. [portal.research.lu.se]
Spine trauma is damage to the spine caused from a sudden traumatic injury caused by an accidental fall or any other physical injury. [newwestsportsmedicine.com]
Car accidents are a common cause of spinal injury, as are sports injuries and falls. [spineuniverse.com]
The primary cause of spinal fractures is high-impact trauma, such as a car accident, a long fall, a sports accident, or a gunshot wound. [rushortho.com]
This is largely due to a trauma injury that produces great force, such as a motor vehicle accident or hard fall, both of which are the leading causes of this injury. [ana-neurosurgery.com]
- Intravenous Drugs
Intravenous drug abusers are more prone to infections affecting the cervical region. [aans.org]
[…] drip method of drug delivery [...] ^ Hirschfeld S, Hyman HT, Wanger JJ (February 1931). "Influence of velocity on the response to intravenous injections". [en.wikipedia.org]
- Pathologist
[…] including any or all of the following: Neurologist/neurosurgeon Orthopedist/orthopedic surgeon Physiatrist Internist Other specialty healthcare providers Rehabilitation specialists Social worker Physical therapist Occupational therapist Speech/language pathologist [hopkinsmedicine.org]
“Leak speech” can be optimised by taking a multidisciplinary approach consulting with the speech pathologist, physiotherapist or respiratory therapist and physician [ 123, 124 ]. [breathe.ersjournals.com]
Gastrointestinal
- Fecal Incontinence
This is followed by a state of hypotension, flaccid paralysis, urinary retention, and fecal incontinence. The symptoms of spinal shock may last a few hours to several days/weeks. [ncbi.nlm.nih.gov]
The lack of function results in fecal incontinence, chronic constipation, or both. Bowel training (during rehab) can help regulate bowel movements but often a care provider is needed to complete the bowel maintenance process. [unitedspinal.org]
[…] interpret the symptoms of AD that occur during sexual activity as pleasant or arousing,[121] or even climactic.[45] A concern for sexual activity that is not dangerous but that can be upsetting for both partners is bladder or bowel leakage due to urinary or fecal [en.wikipedia.org]
Musculoskeletal
- Osteoporosis
Those with osteoporosis induced VCFs are five times more likely to sustain another VCF. Due to osteoporosis, VCFs are a major concern for both elderly women and men. [ana-neurosurgery.com]
They don’t always involve trauma and can result from less common but serious conditions such as infection and cancer or even osteoporosis. [hcahealthcare.co.uk]
Flexion Fracture Pattern Compression fracture: occurs when the bones of the spine (the vertebrae) break, most often caused by osteoporosis, trauma or tumors. [rushortho.com]
If you already have a spinal tumor or osteoporosis, minor blows to the spine can further weaken your bones. [mountsinai.org]
While some fractures are very serious injuries that require emergency treatment, other fractures can be the result of bones weakened by osteoporosis. [orthoinfo.aaos.org]
- Neck Pain
Delayed presentation of neck pain Cases of delayed neck pain following trauma should initially be assessed to exclude cervical spine injury as per acute presentations. [racgp.org.au]
She presents to the ER complaining of localized neck pain and stiffness. On physical exam she has paraspinal tenderness in the cervical region. She has limited motion in all planes secondary to pain. [orthobullets.com]
It usually produces pain in the back or neck; pain, weakness, or numbness in an arm or leg; and paralysis. Fractures, dislocations, deformity, or spinal cord injury also occur commonly with spinal trauma. [mountsinai.org]
“If a person has neck pain, or is not fully awake, or there are other obvious signs of injury, tests such as CT scan, x-rays, and MRIs can be implemented to find out where we are. [orthopedicnj.com]
Required one of the following: neck pain, or no neck pain + all of (injury above clavicles, non ambulatory and dangerous mechanism). Ian Stiells group generated a decision rule with sensitivity of 99.7% and specificity of 50.7 %. [canadiem.org]
- Back Pain
The goal of the surgery is to fuse and repair the fracture, eliminate back pain, and restore posture and ease of movement. The most common surgical procedures for spinal compression fractures are lumbar fusion and vertebroplasty/kyphoplasty. [athensbrainandspine.com]
Symptoms of spinal fractures or dislocations vary, and may include: Neck or back pain. Pain, numbness, tingling or weakness in your arms or legs. Bladder or bowel problems. Partial or complete paralysis. [mercy.net]
[…] and/or numbness of arms or legs, incontinence of bowels and/or bladder Patients may initially have few symptoms, but eventually develop severe back pain. [aans.org]
This type of collision or a fall while in the shower can cause low back pain, but the types of injuries seen are very different from a high speed collision in which the passenger is ejected from the car. [understandspinesurgery.com]
This resulted in the use of spinal immobilization on the majority of trauma patients, regardless of mechanism of injury or presenting symptoms. 5,6 One review estimated that over 50% of trauma patients with no complaint of neck or back pain were transported [mdedge.com]
- Low Back Pain
This type of collision or a fall while in the shower can cause low back pain, but the types of injuries seen are very different from a high speed collision in which the passenger is ejected from the car. [understandspinesurgery.com]
We excluded those with non‐specific low back pain and radicular pain secondary to primary pathological conditions other than congenital or degenerative LSS. [cochranelibrary.com]
De-educate to re-educate: aging and low back pain. Aging Clin Exp Res 2017;29:1261–1269. Ailon T, Shaffrey CI, Lenke LG, Harrop JS, Smith JS. Progressive spinal kyphosis in the aging population. Neurosurgery 2015;77 Suppl 4:S164–S172. [jkoa.org]
It can cause low back pain, weakness or paralysis in the lower limbs, loss of sensation, bowel and bladder dysfunction, and loss of reflexes. Unlike in conus medullaris syndrome, symptoms often occur on only one side of the body. [en.wikipedia.org]
- Muscle Strain
Injuries can affect the bone (fractures), the disks (herniations), ligaments (sprain), or muscles (strain). Each of these tissues has different needs while healing and some take longer than others. Doctors will list the level or levels affected. [understandspinesurgery.com]
Face, Head & Neck
- Facial Pain
Results in ischemia to lateral medulla = wallowing difficulty, or dysphagia, slurred speech, ataxia, facial pain, vertigo, nystagmus, Horner’s syndrome, diplopia, ataxia. [canadiem.org]
Psychiatrical
- Withdrawn
When the needle is withdrawn, the reservoir cover reseals itself. The cover can accept hundreds of needle sticks during its lifetime. [en.wikipedia.org]
Neurologic
- Paresis
It presents with spastic paresis, hyperreflexia, and continued sensory loss. Acute stabilization, a thorough neurological examination, and imaging is required for adequate diagnosis. [amboss.com]
Lesions at the C5 level or higher lead to diaphragmatic paresis or paralysis, as the phrenic nerve arises from the C3-5 levels. [litfl.com]
[…] hands C8-T1 With transverse lesions, Horner's syndrome (ptosis, miotic pupils, facial anhidrosis), paralysis of legs T1-T12 Paralysis of leg muscles above and below the knee At T12 to L1 Paralysis below the knee Cauda equina Hyporeflexic or areflexic paresis [slideshare.net]
Results in loss of position sense Cauda equina lesions due to lumbar fracture loss of bowel and bladder functions, with paresis of LMN type. sensory loss may be patchy plus radicular pain exacerbated by straight leg raising. [aic.cuhk.edu.hk]
Urogenital
- Kidney Failure
The use of intermittent catheterization to empty the bladder at regular intervals throughout the day has decreased the mortality due to kidney failure from UTI in the first world, but it is still a serious problem in developing countries. [en.wikipedia.org]
- Urinary Retention
This is followed by a state of hypotension, flaccid paralysis, urinary retention, and fecal incontinence. The symptoms of spinal shock may last a few hours to several days/weeks. [ncbi.nlm.nih.gov]
EFAST) — Nasogastric tube insertion — spinal patients are at risk of gastric distention — Indwelling catheter insertion — prevent urinary retention and bladder overdistention due to spinal inury; monitor urine output given the risk of hemorrhagic and [litfl.com]
Workup
Although neurologically intact on initial workup, she developed precipitous quadriplegia and apnea in a delayed fashion. Tonsillar herniation with medullary compression and cerebellar infarction was diagnosed on magnetic resonance imaging. [ncbi.nlm.nih.gov]
Other Pathologies
- Gliosis
예를 들어 경추 전방 굴곡 시에는 척추 전방의 골극에 의해서 척수 압박이 발생하고 경추 신전 시에는 추체와 후궁/황색 인대 사이의 척추관이 좁아지면서 척수 압박이 발생한다.13) 경추의 구조적 변화에 따른 만성적 척수 압박은 척수의 경색, 신경염(neuroinflammation), 세포 사멸(apoptosis)과 같은 병태생리학적 변화를 초래하여 척수의 축색돌기 탈수초화(axonal demyelination), 신경증(gliosis), 흉터화(scarring [jkoa.org]
Treatment
Treatments Treatments plans will be based off of the overall health, age and severity of the fracture. [advocatechildrenshospital.com]
From diagnosis to rehabilitation, neurosurgeons at Kaweah Delta will be with you every step of the way through your brain or spinal trauma treatment. Schedule a consultation with your primary care doctor. [kaweahdelta.org]
This type of treatment is almost always urgent and non-elective, exclusively for victims of accident or assault. [metropolitan-neurosurgery.com]
The treatment of a spinal trauma patient does not end with hospital management. [ncbi.nlm.nih.gov]
Prognosis
There are several types of traumatic spinal cord injury 3-5 : spinal cord swelling spinal cord contusion/edema cord edema only: most favourable prognosis cord edema and contusion: intermediate prognosis cord contusion only: worse prognosis intramedullary [radiopaedia.org]
The prognosis is guarded for recumbent horses and cattle. [merckvetmanual.com]
These cases illustrate Cushing's dedication to and rapport with his patients, even in the face of a dismal prognosis. [ncbi.nlm.nih.gov]
References: [1] [2] [3] Complete spinal cord injury Prognosis In acute spinal cord injury ( spinal shock ), flaccid paralysis and a complete absence of reflexes occur below the injury. [amboss.com]
Etiology
Core Content Outline: Cervical Spine Injury Etiology Understand the most common etiologies of cervical spine injuries in children Know mechanisms and patterns of injury associated with cervical spine injuries in children Pathophysiology Understand the [reliasmedia.com]
Various etiologies, such as coagulation disorders and vascular malformations have been described [3,4,5,6,7,8,9]. [bmcpediatr.biomedcentral.com]
This activity provides a concise introduction to the care of these patients.[1] Etiology Spinal shock has been described initially in a patient with transected spinal cord and difficult to treat hypotension as a result of decreased sympathetic tone throughout [ncbi.nlm.nih.gov]
Subluxation may also be an asymptomatic complicating factor to those etiologic factors mentioned above. [chiro.org]
High blood glucose levels has been described as one of the most common etiology for translocational hyponatremia. [jadweb.org]
Epidemiology
Spinal cord injury in Manitoba: a provincial epidemiological study. J Spinal Cord Med. 2011;34(1):6-10. Cripps RA, Lee BB, Wing P, Weerts E, Mackay J, Brown D. [msjonline.org]
The global map for traumatic spinal cord injury epidemiology: update 2011, global incidence rate. Spinal Cord. 2014;52(2):110-6. [ Links ] 10 Devivo MJ. Epidemiology of traumatic spinal cord injury: trends and future implications. [scielo.br]
Epidemiological trends of spine trauma: An Australian Level 1 Trauma Centre Study. Global Spine J 2013; 3: 75–84. 13 Ackery A, Tator C, Krassiokov A. A global perspective on spinal cord injury epidemiology. [nature.com]
Epidemiological data were collected, along with data on injury mechanism, injury intent, toxicology screen results, primary payer, Injury Severity Score (ISS), hospital length of stay (LOS), discharge location, and mortality. [thejns.org]
Epidemiologic studies have found that the average age of a spinal cord injury patient is gradually increasing with an increase in the percentage of female patients, unlike in the 1980s when a typical spinal cord injury patient was a young male involved [journals.lww.com]
Pathophysiology
Pathophysiology, presentation and management of spinal cord injury. Surgery. 2015;33(6):238–47. Sekhon H.S. L, G. Fehlings M. Epidemiology, demographics, and pathophysiology of acute spinal cord injury. Spine. 2001;26(24S):S2–12. [medigraphic.com]
Perhaps such techniques would allow more insights into the ongoing pathophysiologic changes present in the acute and chronically injured spine. [ajnr.org]
Pathophysiology of spinal trauma The pathophysiological events in the human body following traumatic injury involve the participation of chiefly two mechanisms: the primary injury and secondary injury[2]. [jadweb.org]
Research endeavors in the realm of spinal cord injury recovery and regeneration research are expanding at a rapid pace as our understanding of spinal cord pathophysiology improves through basic science and clinical research. [journals.lww.com]
척수손상의 병리 및 병태생리 Pathology and pathophysiology of spinal cord injury >>> 479 21. 척추손상의 분류 및 응급처치 Classification and emergency care of spine injury >>> 489 22. 척추손상의 집중치료 Intensive care for spine injury >>> 509 23. [mdon.co.kr]
Prevention
In selected cases, neurosurgeons may remove part of the skull to alleviate pressure on the brain and prevent further swelling. People who have suffered a spinal injury require immediate treatment to prevent further damage to the spinal cord. [nyp.org]
The majority of spinal cord injuries are due to preventable causes such as road traffic crashes, falls or violence. [who.int]
These are all preventable injuries and can be avoided if people are educated and safety norms are practiced mandatorily. [ncbi.nlm.nih.gov]
How do you Prevent a Spinal Cord Injury? Following are a few measures to be taken to prevent a spinal cord injury. [medindia.net]
Treatment Options for Spinal Trauma Spinal trauma requires immediate treatment, usually at the site of the injury, to prevent additional injury to the spinal cord. [neurosurgeonsofnewjersey.com]