Acute Traumatic Spinal Cord Injury and Cervical Spine Injuries

David Marck^*
*Correspondence: David Marck, Department of Neuroscience, Stanford University, USA, Email:

Introduction

Because of the complex injury patterns that necessitate rapid surgical treatment, primary surgical care of acute traumatic spinal cord injury (SCI) is a challenge for trauma centres. Although traumatic SCI is uncommon, those who have it are susceptible since clinical the options for recovering their usually severe neurofunctional deficits are limited, and studies on neurorestorative therapy require a good starting point. As a result, secondary spinal cord insults caused by spinal surgical adverse events (SSAE) are expected to have a significant impact on the clinical outcome following SCI.

Description

SSAE rates of 10% to 15% for the treatment of spine fractures have been reported in studies on spinal surgery in general. SSAE rates are likely to be significantly higher after SCI. SSAE literature specific to SCI is, however, sparse. Furthermore, the interpretation and generalizability of published evidence is complicated by heterogeneity in the aetiology of spine fractures, anatomical locations with associated organ and circulatory systems, surgical techniques, the timing of SSAE occurrence, and SSAE causality. In addition, because vertebral fractures with SCI necessitate quick and adequate decompression of the spinal canal to prevent ischemia secondary injury to the enlarged spinal cord, poor decompression is an SSAE of particular importance after SCI. The occurrence and nature of SSAE in acute traumatic cervical SCI, as well as the influence of SSAE on the clinical, functional, and health-economic outcomes after primary surgical care, were evaluated in a Level I trauma hospital with specialist SCI care.

Urinary tract infections, thrombosis, and pulmonary embolism were the most common secondary problems in studies combining all spinal surgical procedures. In general, fatality rates of up to 0.4 percent are higher after cervical spine surgeries (0.9 percent) or for fracture repair (1 percent). In patients of cervical SCI, this study found a substantially higher burden of secondary sequelae and a higher fatality rate after spinal surgery. When comparing this study to previous SCI-specific investigations, the incidence of secondary complications is similar. SSAE may, however, contribute to a higher susceptibility to specific secondary problems, as the matched sample likewise found a relationship between SSAE and these complications. Higher mortality in the SSAE group, on the other hand, was only detected in the overall sample, not in the matched sample. As a result, it's safe to believe that the patient's injuries and baseline conditions had a greater impact on mortality than SSAE [1-3].

In terms of neurological outcome, the 12.8 percent risk of AIS deterioration in the SSAE group in the matched sample is comparable to earlier studies on spinal surgery of any cause with neurological deterioration rates as high as 17 percent. Furthermore, in this study's matched sample, SSAE was linked to a decreased likelihood of AIS conversion. In terms of the significance of SSAE subtypes, such as insufficient spinal decompression, the finding that none of the patients with this kind of SSAE experienced an AIS-conversion compared to patients with other SSAE should be regarded with caution, given the small size of the SSAE subgroups. Furthermore, the link between a singlesided surgical approach (ventral or dorsal) and poor neurological result must be carefully evaluated and merits further research in prospective multicenter investigations. The findings, however, show that SSAE is not just linked to abrupt neurological deterioration, but that it is especially important for SCI patients since SSAE can further reduce their already restricted capacity for neurological recovery [4,5].

Conclusion

When compared to other reasons for spinal surgery, surgery for cervical spine fractures with SCI is associated with a higher likelihood of SSAE. Male sex and, to a lesser extent, older age, comorbidities, motor full SCI, or a single-sided surgical technique are all risk factors for SSAE. After cervical SCI, SSAE are linked to a larger burden of SCI-related secondary sequelae, a poorer neurological outcome, higher rates of permanent dysphagia, and higher surgical and treatment expenses. To protect the outcome of SCI patients with cervical spine fractures, persistent high-quality management in the emergency setting in specialised spine facilities is necessary. Improving surgical care to lower SSAE and, as a result, poor neurological outcomes and dysphagia, is an attainable goal that can have a positive impact on patients' quality of life.

References

1. Aghdasi, B., S. R. Montgomery, M. D. Daubs and J. C. Wang. "A review of demineralized bone matrices for spinal fusion: the evidence for efficacy." Surgeon 11(2013): 39-48.

Indexed at, Crossref, Google Scholar

2. Ahmed, Tamer A.E., Emma V. Dare and Max Hincke. "Fibrin: a versatile scaffold for tissue engineering applications." Tissue Eng Part B Rev 14 (2008): 199-215.

Indexed at, Crossref, Google Scholar

3. Albanese, Antonino, Maria E. Licata, Bianca Polizzi, and Giuseppina Campisi. "Platelet-rich plasma (PRP) in dental and oral surgery: From the wound healing to bone regeneration." Immun Ageing 10 (2013): 1-10.

Indexed at, Crossref, Google Scholar

4. Alberio, L., O. Safa, Kenneth John Clemetson, C.T. Esmon and G.L. Dale. "Surface expression and functional characterization of α-granule factor V in human platelets: Effects of ionophore A23187, thrombin, collagen, and convulxin." Am J Hematol 95 (2000): 1694-1702.

Indexed at, Crossref, Google Scholar

5. Alsousou, J., M. Thompson, P. Hulley and K. Willett, et al. "The biology of platelet-rich plasma and its application in trauma and orthopaedic surgery: A review of the literature." J Bone Jt Surg 91 (2009): 987-996.

Crossref, Google Scholar