Musculoskeletal Trauma in Infants and Children: Accidental or Inflicted?
B. G. Brogdon, Tor Shwayder, Jamie Elifritz in Child Abuse and Its Mimics in Skin and Bone, 2012
The unusually elastic biomechanics of the pediatric spine allow traumatic deformations beyond physiologic limits, permitting spinal cord trauma from hyperextension/flexion, longitudinal distraction, or vascular compromise, followed by spontaneous reduction of the spinal displacement. In the absence of fracture, this may only be apparent radiographically by lateral subluxation (Figure 2.45), paraspinous soft tissue widening (Figure 2.46), or increased separation of spinous processes on either AP or lateral projections (Figure 2.47). In children the separation of the usual spinous processes of C1 and C2 can be somewhat variable on the routine cross-table lateral projection. If in doubt go immediately to CT. At other levels the separation should not be appreciably different from that of the spine above and below. Symptoms of spinal cord injury may be delayed and, when apparent, may call for intensive further investigation with sectional imaging studies (CT and MRI).
Fractures and Joint Injuries
Louis Solomon, David Warwick, Selvadurai Nayagam in Apley and Solomon's Concise System of Orthopaedics and Trauma, 2014
Certain fractures are apt to cause secondary injuries and these should always be assumed to have occurreduntil proved otherwise. Thoracic injuries: fractured ribs or sternum may be associated with injury to the lungs or heart. It is essential to check cardiorespiratory function.Spinal cord injury: with any fracture of the spine, neurological examination is essential: (a) to establish whether the spinal cord or nerve roots have been damaged; and (b) to obtain a baseline for later comparison if neurological signs should change.Pelvic and abdominal injuries: fractures of the pelvis may be associated with visceral injury. Enquire about urinary function and look for blood at the urethral meatus. Diagnostic urethrograms or cystograms may be necessary.Pectoral girdle injuries: fractures and dislocations around the pectoral girdle may damage the brachial plexus or the large vessels at the base of the neck. Neurological and vascular examinations are essential.
Pharmacokinetic-Pharmacodynamic Correlations of Corticosteroids
Hartmut Derendorf, Günther Hochhaus in Handbook of Pharmacokinetic/Pharmacodynamic Correlation, 2019
Ultra-high doses of corticosteroids (0.5 to 10 g/d) are used to treat various diseases such as spinal cord injury, cardiac infarction, and arthritis, as well as for inhibition of graft rejection.134 These high doses result in plasma and tissue concentrations of 10−4 to 10−5 mol/1, which is far above receptor saturation (10−6 to 10−8 mol/1).58 Efficacy cannot be explained by a receptor-mediated effect. Despite the common clinical application, not much is known about the mode of action. Therapy for the acute spinal cord injury is under intense investigation and is reviewed by several authors.4,157–159 The main mechanism seems to be facilitation of the spinal cord impulse generation, due to hyperpolarization of the resting membrane potential as well as enhancing the excitability of spinal motor neurons. Additionally, improved blood flow in the injured spinal cord was reported. Interference with vasoconstrictor effects, sympathetic response, prostaglandin and thromboxan synthesis, and direct vasodilatation are all proposed mechanisms. During hypoxia induced by spinal cord injury, free radicals are generated in the membrane, which attack unsaturated lipids and inhibit neuronal key enzymes such as the sodium/potassium-ATPase.4 There is evidence that large doses of corticosteroids, especially MP, protect the membrane from free radicals.160
Determining the spiritual well-being of patients with spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2020
Semra Aktürk, Ümmühan Aktürk
Spinal cord injury (SCI) often occurs with trauma of the vertebrae that carry, protect, and move the spinal cord. Injury to the spinal cord is the result of compression, contusion, or crossing.1 The causes of spinal cord injury can include traffic accidents, falls from a height, sports injuries, occupational accidents, shallow water diving, and everyday accidents, as well as a primary pathology of the vertebrae and the spinal cord itself (tumour, infection, bone diseases).2 According to the WHO, between 250,000 and 500,000 people worldwide suffer a spinal cord injury each year. The majority of spinal cord injuries are due to preventable causes, such as road traffic crashes, falls, or violence. People with a spinal cord injury are two to five times more likely to die prematurely than people without a spinal cord injury, with worse survival rates in low- and middle-income countries.21 Turkey’s current population is approximately 80 million,22 and there are approximately 650-1700 new SCI cases in Turkey each year.
Effect of selegiline as a monomine oxidase B inhibitor on the expression of neurotrophin mRNA levels in a contusion rat model of spinal cord injury
Published in Neurological Research, 2023
Alireza Abdanipour, Mojgan Mirzaei, Iraj Jafari Anarkooli, Parvin Mohammadi
Hind limb scores were recorded 3, 7, 14, 21 and 28 days after injury. In a spinal cord injury model, this test was performed to assess motor function. The behavioral study was conducted in two phases: the pre-test and the main test. In the preliminary test, all rats received 21 BBB points. Statistically significant differences between groups were determined using a one-way analysis of variance. The Tukey post hoc test showed significant differences between the selegiline treated group compared to the untreated contusion, sham and laminectomy groups at day 14 and 21 as follows: day of 14 (Contusion: 2.75 ± 0.72, laminectomy: 19.20 ± 0.73, sham: 4.5 ± 1.25, treatment: 8.91 ± 1.17); day of 21 (Contusion: 3.08 ± 0.63, laminectomy: 20.6 ± 0.24, sham: 4.5 ± 1.25, treatment: 11.16 ± 0.73); day of 28 (Contusion: 3.5 ± 0.65, laminectomy: 20.6 ± 0.24, sham: 5 ± 1.29, treatment: 12.5 ± 0.5) (Figure 1).
Regenerative replacement of neural cells for treatment of spinal cord injury
Published in Expert Opinion on Biological Therapy, 2021
William Brett McIntyre, Katarzyna Pieczonka, Mohamad Khazaei, Michael G. Fehlings
Another common line of treatment following spinal cord injury involves physical rehabilitation, which has been associated with functional improvements. Fundamentally, physical activity is able to mitigate cellular pathophysiology, which makes it a promising conjunctive therapy. At the level of the neuron, exercise is associated with a decrease in neuronal apoptosis [32] and a reduction in motor neuron dendritic atrophy, thus indicating that it is beneficial for maintaining synaptic integrity [33]. Interestingly, exercise induces upregulation of the expression of proteins and trophic factors that are involved in the survival of motor neurons and sensory neurons. As such, exercise may have ranging implications for different types of neurons [33]. In the context of oligodendrocytes, physical activity may reduce demyelination and/or improve remyelination, as it is associated with an increased number of myelinated axons in a model of peripheral nerve damage [34]. Finally, exercise is associated with a decrease in phagocytic and reactive glia, which may restrict glial scar formation [32].
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