Presentation
Cushing performed laminectomies within 24 hours on patients with immediate presentations-both complete and incomplete spinal cord lesions. [ncbi.nlm.nih.gov]
Further, they advise “utilization of backboards for spinal immobilization during transport should be judicious, so that potential benefits outweigh risks.” 1 Spinal immobilization should not be used at all in patients with penetrating trauma who do not present [mdedge.com]
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
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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]
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]
It is performed in patients who have persistent tailbone pain due to injury, fall or contact sports and when all other conservative treatments are a failure. [newwestsportsmedicine.com]
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 can consist of pain, swelling, trouble moving and walking. Testing & Diagnosis Physicians will conduct a thorough family and medical history followed by a complete and accurate diagnosis. [advocatechildrenshospital.com]
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Falling
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]
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]
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]
The most common spinal cord injuries in children occur when the spine or neck is bent or compressed, as in the following: Birth injuries, typically affecting the spinal cord in the neck area Diving accidents Falls Infection that causes an abscess on the [childrens.com]
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Disturbance of Growth
Although fractures were less common in the younger than 8 group, they do occur in younger children through the cartilaginous endplates and can produce a disturbance of growth. 2 Spinal cord injury is relatively more common in younger than in older children [journals.lww.com]
Musculoskeletal
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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]
Neck pain and signs or symptoms of spinal cord injury should prompt investigation when there is a history of severe trauma. [journals.lww.com]
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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]
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]
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]
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]
Moderate to severe back pain is the main symptom of spinal trauma or fracture. This pain is worsened with movement. If the spinal cord is also injured, the patient may experience numbness, tingling, weakness or bowel/bladder complications. [rushortho.com]
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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]
The patient is instructed to breathe normally, flex forward at the waist (when low-back pain is absent), and then bring the arms back and up in an arc from the anterior to the posterior as far as can be comfortably managed. [chiro.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]
Neurologic
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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. [lifeinthefastlane.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]
Horner syndrome (ptosis, miotic pupils, facial anhidrosis) Paralysis of legs Between T1 and T12 Paralysis of leg muscles above and below the knee At T12 to L1 Paralysis below the knee Cauda equina (usually about L2 to S5) Hyporeflexic or areflexic paresis [msdmanuals.com]
Urogenital
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Urinary Retention
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 [lifeinthefastlane.com]
We get most of our patients with deformed spine with concomitant complications of SCI such as pressure sores, urinary retention and infection, deep vein thrombosis. [ncbi.nlm.nih.gov]
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]
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]
Treatment of traumatic thoracolumbar spine fractures: a multicenter prospective randomized study of operative versus nonsurgical treatment. [academic.oup.com]
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]
Surgery is recommended when other treatments are a failure or inappropriate. Surgery for spinal condition depends on the type and severity of injury. [newwestsportsmedicine.com]
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]
[…] when compared with clinical predictors, but confirmed that the presence of hemorrhage was associated with a worse prognosis. [appliedradiology.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]
Subluxation may also be an asymptomatic complicating factor to those etiologic factors mentioned above. [chiro.org]
J Trauma 1987; 27:980–6Reid, DC Henderson, R Saboe, L Miller, JDR Davis JW, Phreaner DL, Hoyt DB, MacKersie RC: The etiology of missed cervical spine injuries. [anesthesiology.pubs.asahq.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
Perhaps such techniques would allow more insights into the ongoing pathophysiologic changes present in the acute and chronically injured spine. [ajnr.org]
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]
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]
The second group, treatments targeting the pathophysiology of spinal injuries, encompasses timing of surgery in spinal trauma, hypothermia, lumbar drainage, and diffusion MRI. [academic.oup.com]
Prevention
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]
Emergency Medicine. 2016 April;48(4):152-157 Prehospital spinal immobilization has long been the standard of care (SOC) to prevent spinal cord injury in trauma patients, but utilizing the best data currently available, some professional societies recently [mdedge.com]
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]
These are all preventable injuries and can be avoided if people are educated and safety norms are practiced mandatorily. [ncbi.nlm.nih.gov]
Prevention The following measures may help prevent SCIs: Proper safety practices during work and play can prevent many spinal cord injuries. Use protective equipment for any activity in which an injury is possible. [pennstatehershey.adam.com]