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![American Spinal Injury Association (ASIA) Form [84].](publication/361226587/figure/fig1/AS:1171045167960077@1656210333750/American-Spinal-Injury-Association-ASIA-Form-84_Q320.jpg)
Purpose of Review
This review provides guidance for acute spinal cord injury (SCI) management through an analytical assessment of the most recent evidence on therapies available for treating SCI, including newer therapies under investigation. We present an approach to the SCI patient starting at presentation to acute rehabilitation and prognosticat...
Citations
... Pain management in patients with SCIs can be a challenging matter, and it is best to have an experienced pain-management team in these cases [112]. Although it is always better to start with medications that do not impair respiratory drive and to avoid the ones that can cause cardiac and behavioral complications, many patients will need medications targeting neuropathic pain [113]. ...
... Depending on the level of injury, patients will have either upper or lower motor neuron bowel patterns. An upper motor neuron bowel pattern results in hyperreflexic bowels and a spastic anal sphincter, and the patient will present with constipation and retention [112]. With a lower motor neuron bowel pattern, the patient will present with an areflexic bowel and atonic external anal sphincter, which will lead to a mix of constipation and incontinence [112]. ...
... An upper motor neuron bowel pattern results in hyperreflexic bowels and a spastic anal sphincter, and the patient will present with constipation and retention [112]. With a lower motor neuron bowel pattern, the patient will present with an areflexic bowel and atonic external anal sphincter, which will lead to a mix of constipation and incontinence [112]. ...
A spinal cord injury (SCI) can be a devastating condition in children, with profound implications for their overall health and quality of life. In this review, we aim to provide a concise overview of the key aspects associated with SCIs in the pediatric population. Firstly, we discuss the etiology and epidemiology of SCIs in children, highlighting the diverse range of causes. We explore the unique anatomical and physiological characteristics of the developing spinal cord that contribute to the specific challenges faced by pediatric patients. Next, we delve into the clinical presentation and diagnostic methods, emphasizing the importance of prompt and accurate diagnosis to facilitate appropriate interventions. Furthermore, we approach the multidisciplinary management of pediatric SCIs, encompassing acute medical care, surgical interventions, and ongoing supportive therapies. Finally, we explore emerging research as well as innovative therapies in the field, and we emphasize the need for continued advancements in understanding and treating SCIs in children to improve their functional independence and overall quality of life.
... Pain management in SCI can be a challenge matter and it is always better to have a experienced pain management team in these cases [ 103 ]. Although it is always better to start with medications that do not impair respiratory drive and to avoid the ones that can cause cardiac and behavioral complications, many patients will need medications targeting neuropathic pain [ 104 ]. ...
... Depending on the level of the injury, patients will have either upper or lower motor neuron bowel patterns. The first one results in hyperreflexic bowels and spastic anal sphincter, and the patient will present with constipation and retention [ 103 ]. The second pattern will present with an areflexic bowel and atonic external anal sphincter which will lead to a mix of constipation and incontinence [ 103 ]. ...
... The first one results in hyperreflexic bowels and spastic anal sphincter, and the patient will present with constipation and retention [ 103 ]. The second pattern will present with an areflexic bowel and atonic external anal sphincter which will lead to a mix of constipation and incontinence [ 103 ]. ...
Spinal Cord Injury in children can be a devastating condition in children with profound implications for their overall health and quality of life. In this review we aim to provide a concise overview of the key aspects associated with SCI in pediatric population. Firstly, we discuss the etiology and epidemiology of SCI in children, highlighting the diverse range of causes. We explore the unique anatomical and physiological characteristics of the developing spinal cord that contribute to the specific challenges faced by pediatric patients. Next, we delve into the clinical presentation and diagnostic methods, emphasizing the importance of prompt and accurate diagnosis to facilitate appropriate interventions. Furthermore, we approach the multidisciplinary management of pediatric SCI, encompassing acute medical care, surgical interventions, and ongoing supportive therapies. Finally, we explore emerging research and innovative therapies in the field and we emphasize the need for continued advancements in understanding and treating SCI in children to improve their functional independence and overall quality of life.
... Pain management in SCI can be a challenge matter and it is always better to have a experienced pain management team in these cases [103]. Although it is always better to start with medications that do not impair respiratory drive and to avoid the ones that can cause cardiac and behavioral complications, many patients will need medications targeting neuropathic pain [104]. ...
... Depending on the level of the injury, patients will have either upper or lower motor neuron bowel patterns. The first one results in hyperreflexic bowels and spastic anal sphincter, and the patient will present with constipation and retention [103]. The second pattern will present with an areflexic bowel and atonic external anal sphincter which will lead to a mix of constipation and incontinence [103]. ...
... The first one results in hyperreflexic bowels and spastic anal sphincter, and the patient will present with constipation and retention [103]. The second pattern will present with an areflexic bowel and atonic external anal sphincter which will lead to a mix of constipation and incontinence [103]. ...
Spinal Cord Injury in children can be a devastating condition in children with profound implications for their overall health and quality of life. In this review we aim to provide a concise overview of the key aspects associated with SCI in pediatric population. Firstly, we discuss the etiology and epidemiology of SCI in children, highlighting the diverse range of causes. We explore the unique anatomical and physiological characteristics of the developing spinal cord that contribute to the specific challenges faced by pediatric patients. Next, we delve into the clinical presentation and diagnostic methods, emphasizing the importance of prompt and accurate diagnosis to facilitate appropriate interventions. Furthermore, we approach the multidisciplinary management of pediatric SCI, encompassing acute medical care, surgical interventions, and ongoing supportive therapies. Finally, we explore emerging research and innovative therapies in the field and we emphasize the need for continued advancements in understanding and treating SCI in children to improve their functional independence and overall quality of life.
... In the US, there is an annual incidence of SCI of approximately 18,000 new cases per year [2]. While the chances of SCI occurring in individuals is relatively low (around 54 patients per one million in the USA [2][3][4], young adults and the elderly are mostly affected, with the average age climbing from 29 years during the since CSF is not routinely collected and is not considered part of the standard management of SCI [20]. In addition, a lumbar puncture is an invasive procedure [21] and it may also produce serious complications, including subdural hematoma [22]. ...
Acute traumatic spinal cord injury (SCI) is recognized as a global problem that can lead to a range of acute and secondary complications impacting morbidity and mortality. There is still a lack of reliable diagnostic and prognostic biomarkers in patients with SCI that could help guide clinical care and identify novel therapeutic targets for future drug discovery. The aim of this prospective controlled study was to determine the cerebral spinal fluid (CSF) and serum profiles of 10 biomarkers as indicators of SCI diagnosis, severity, and prognosis to aid in assessing appropriate treatment modalities. CSF and serum samples of 15 SCI and ten healthy participants were included in the study. The neurological assessments were scored on admission and at discharge from the hospital using the American Spinal Injury Association Impairment Score (AIS) grades. The CSF and serum concentrations of SBDP150, S100B, GFAP, NF-L, UCHL-1, Tau, and IL-6 were significantly higher in SCI patients when compared with the control group. The CSF GBDP 38/44K, UCHL-L1, S100B, GFAP, and Tau levels were significantly higher in the AIS A patients. This study demonstrated a strong correlation between biomarker levels in the diagnosis and injury severity of SCI but no association with short-term outcomes. Future prospective controlled studies need to be done to support the results of this study.
... Secondary damage is caused by vascular and biochemical effects. Secondary damage mechanisms are manifested in the form of vascular and biochemical disturbances that lead to an imbalance of the physiology of the microenvironment and are accompanied by hypoxia, hypoperfusion, inflammation, edema, microhaemorrhages and thrombosis (Blando et al., 2022;Thomas et al., 2022). ...
The importance of identification and differential diagnosis of spinal injuries, in the case of polytrauma, the ability to distinguish the pathogenesis of various injuries are important and relevant both during clinical and during pathological examination of the animal’s body. The purpose of research is to provide veterinary practitioners and lawyers with strategies for identifying the cause (mechanism) of spinal cord injury and to assist triers of fact (decision-makers) in arriving at plausible and reasoned veterinary forensic conclusions. The research was performed using pathological and anatomical dissection and histological studies. It was established that damage to the cervical spinal cord due to traumatic bending of the neck was accompanied by partial or complete rupture of the intervertebral disc and destruction of the ligaments of the vertebrae. It was found that the hyperemia of the vessels of the meninges of the brain is the result of blood circulation disorders in the occipital artery and the caudal artery of the meninges, and mechanical damage to the integrity of the intervertebral discs or the destruction of the ligaments of the neck vertebrae led to various disorders of the innervation of various organs and systems of the body and ended the death of animals. It was proved that the distraction injury of the cervical spine led to the swelling of the medulla of the brain, haemorrhages of the caudalventral part of the brain substance. It was found that irritation of nervus vagus led to hyperemia of vessels of large (aorta and trunk of pulmonary artery) caliber, cranial mesenteric artery) caudal mesenteric artery and, accordingly, hyperemia of thoracic and abdominal organs. Application of research results will help in differentiation of various types of mechanical injuries of the spine (including differentiation from other pathological conditions of the body), determination of the area of the applied force vector
... As with the intracranial portions of the CNS, the spinal cord is also highly vulnerable to damage, especially to crush injury. If severe, such damage can permanently incapacitate an individual, and research into methods/drugs to improve recovery are under intensive investigation [136]. Samantaray and colleagues [137] used a standard weight drop technique to the exposed rat spinal cord during laminectomy to simulate a crush injury. ...
The aim of this review is to provide the reader with a general overview on the rationale for the use of melatonin by military personnel. This is a technique that is being increasingly employed to manage growing psycho-physical loads. In this context, melatonin, a pleotropic and regulatory molecule, has a potential preventive and therapeutic role in maintaining the operational efficiency of military personnel. In battlefield conditions in particular, the time to treatment after an injury is often a major issue since the injured may not have immediate access to medical care. Any drug that would help to stabilize a wounded individual, especially if it can be immediately administered (e.g., per os) and has a very high safety profile over a large range of doses (as melatonin does) would be an important asset to reduce morbidity and mortality. Melatonin may also play a role in the oscillatory synchronization of the neuro–cardio–respiratory systems and, through its epigenetic action, poses the possibility of restoring the main oscillatory waves of the cardiovascular system, such as the Mayer wave and RSA (respiratory sinus arrhythmia), which, in physiological conditions, result in the oscillation of the heartbeat in synchrony with the breath. In the future, this could be a very promising field of investigation.
Fluid and vasopressors are the backbone of all cases presenting to the critical care units. Vasopressors increase the vascular tone, and this effect is variable in different vascular beds of the body. Inotropes differ from vasopressors as they increase the cardiac contractility, however many drugs categorised as inotropes has both isotropic and vasopressor effects. Many a times terms vasopressor and inotrope are used interchangeably in clinical practice. These vasoactive drugs act via various adrenergic and dopaminergic receptors, spread widely throughout the body. Each drug has variable effect on the receptor subtype and thus has different vasospastic/ hemodynamic effect. These physiologic effects of vasoactive drugs are also associated with metabolic effects. The dose, rate, and duration of these agents to be used have been debated in various studies. In order to use vasopressors, one must have basic knowledge of these agents so that vasopressors can be used appropriately for the situation in hand. We, in this article, will be discussing different vasopressors and inotropes and their mechanism of action and uses in neurocritical care settings.
Spinal cord injury (SCI) is a primary lesion of the spinal cord that results from external forces or diseases, accompanied by a cascade of secondary events. Nitric oxide, an endogenous gas that functions as a signaling molecule in the human body, plays a crucial role in vasodilation of smooth muscles, regulation of blood flow and pressure, and inflammatory response. This article provides a comprehensive overview of the involvement of nitric oxide in SCI and highlights recent advances in basic research on pharmacological agents that inhibit nitric oxide elevation after SCI, offering valuable insights for future therapeutic interventions targeting SCI.
La lesión de la médula espinal (LME) aguda es un evento traumático y catastrófico que puede causar una disfunción grave en la condición neurológica tanto motora, sensitiva como autónoma. Con el fin de evitar o de disminuir los efectos lesivos en la médula espinal se han desarrollado múltiples estudios de evaluación de la metilprednisolona (MPS), sin embargo, hasta la actualidad su uso sigue siendo controvertido y polémico. Resumir de manera práctica y sencilla el adecuado uso de la MPS en la LME aguda. En diciembre del 2023 realizamos una revisión respecto al uso de la MPS en la LME, la búsqueda se realizó en las bases de datos de PubMed, MEDLINE, EMBASE y Google Académico de los últimos 6 años. Se identificaron 20 estudios relacionados con el uso de MPS. Se recopiló la información para un adecuado uso de la MPS en la LME. El uso de MPS es el único tratamiento sugerido en ensayos clínicos, sin embargo, no ha logrado una mejoría estadísticamente significativa administrada dentro de las primeras 8 a 12 horas de la LME, además, aumentó el riesgo de hiperglucemia, infección de heridas, compromiso respiratorio, hemorragia gastrointestinal y muerte. No recomendamos el uso de MPS en pacientes con LME.
