Spinal Cord Injury-What Are the Controversies?

Abstract:

:Traumatic spinal cord injuries have a tremendous impact on individuals, families, and society as a whole. Substantial heterogeneity in the patient population, their presentation and underlying pathophysiology has sparked debates along the care spectrum from initial assessment to definitive treatment. This article reviews spinal cord injury (SCI) management followed by a discussion of the salient controversies in the field. Current care practices modeled on the American Association of Neurological Surgeons/Congress of Neurological Surgeons joint section guidelines are highlighted including key recommendations regarding immobilization, avoidance of hypotension, early International Standards for Neurological Classification of SCI examination and intensive care unit treatment. From a diagnostic perspective, the evolving roles of CT, MRI, and leading-edge microstructural MRI techniques are discussed with descriptions of the relevant clinical literature for each. Controversies in management relevant to clinicians including the timing of surgical decompression, methylprednisolone administration, blood pressure augmentation, intraoperative electrophysiological monitoring, and the role of surgery in central cord syndrome and pediatric SCI are also covered in detail. Finally, the article concludes with a reflection on clinical trial design tailored to the heterogeneous population of individuals with SCI.

journal_name

J Orthop Trauma

authors

Ahuja CS,Schroeder GD,Vaccaro AR,Fehlings MG

doi

10.1097/BOT.0000000000000943

subject

Has Abstract

pub_date

2017-09-01 00:00:00

pages

S7-S13

eissn

0890-5339

issn

1531-2291

pii

00005131-201709004-00002

journal_volume

31 Suppl 4

pub_type

杂志文章,评审
  • A prospective study of pain reduction and knee dysfunction comparing femoral skeletal traction and splinting in adult trauma patients.

    abstract:OBJECTIVES:To determine if distal femoral traction pins result in knee dysfunction in patients with femoral or pelvic fracture, and to determine if skeletal traction relieves pain more effectively than splinting for femoral shaft fractures. DESIGN:Prospective cohort trial. SETTING:Level I urban trauma center. PATIEN...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000000202

    authors: Bumpass DB,Ricci WM,McAndrew CM,Gardner MJ

    更新日期:2015-02-01 00:00:00

  • Bone and cartilage formation in an experimental model of distraction osteogenesis.

    abstract:OBJECTIVES:(a) To develop a reliable and reproducible system for distraction osteogenesis in the rat to establish a model for future investigations of bone repair and regeneration. (b) To describe and characterize the histological events in distraction osteogenesis in the rat and to determine whether cartilage developm...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/00005131-199802000-00008

    authors: Jazrawi LM,Majeska RJ,Klein ML,Kagel E,Stromberg L,Einhorn TA

    更新日期:1998-02-01 00:00:00

  • Teamwork in Trauma: System Adjustment to a Protocol for the Management of Multiply Injured Patients.

    abstract:OBJECTIVES:We developed a protocol to determine the timing of definitive fracture care based on the adequacy of resuscitation. Inception of this project required a multidisciplinary group, including physicians from anesthesiology, general trauma and critical care, neurosurgery, orthopaedic spine, and orthopaedic trauma...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000000383

    authors: Vallier HA,Moore TA,Como JJ,Dolenc AJ,Steinmetz MP,Wagner KG,Smith CE,Wilczewski PA

    更新日期:2015-11-01 00:00:00

  • Immediate Weight Bearing and Range of Motion After Internal Fixation of Selected Malleolar Fractures: A Retrospective Non-Inferiority Controlled Study.

    abstract:OBJECTIVES:We studied the safety of immediate weight bearing as tolerated (IWBAT) and immediate range of motion (IROM) following open reduction internal fixation (ORIF) of selected malleolar ankle fractures (defined as involving bony or ligamentous disruption of two or more of the malleoli or syndesmosis without articu...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000002003

    authors: Fram BR,Rogero RG,Chang G,Krieg JC,Raikin SM

    更新日期:2020-11-09 00:00:00

  • Observed and expected outcomes in transfer and nontransfer patients with a hip fracture.

    abstract:OBJECTIVES:Hospitals and providers that accept transfer patients risk lower ratings on publically reported quality measures that are inadequately adjusted for infirmity and complexity. We compared the outcomes of transferred patients and nontransferred patients after treatment of a hip fracture and sought to determine ...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0b013e31821146b1

    authors: Wiggers JK,Guitton TG,Smith RM,Vrahas MS,Ring D

    更新日期:2011-11-01 00:00:00

  • Unexpected high complication rate following internal fixation of unstable proximal humerus fractures with an angled blade plate.

    abstract:OBJECTIVES:The increasing number of fractures of the proximal humerus, especially in the elderly, carries with it the unsolved problem of the optimal treatment for the displaced or unstable fractures. The authors' goal was to analyze whether fixation with a bent valgus angled blade plate could improve the outcomes repo...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/00005131-200604000-00004

    authors: Meier RA,Messmer P,Regazzoni P,Rothfischer W,Gross T

    更新日期:2006-04-01 00:00:00

  • Modified Judet approach and minifragment fixation of scapular body and glenoid neck fractures.

    abstract:OBJECTIVES:To describe the technique and to determine the outcome of operatively treated displaced scapular body or glenoid neck fractures using minifragment fixation through a modified Judet approach. DESIGN:Retrospective review of scapular or glenoid fractures. SETTING:Level 1 teaching trauma center. PATIENTS:All ...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0b013e3181a18216

    authors: Jones CB,Cornelius JP,Sietsema DL,Ringler JR,Endres TJ

    更新日期:2009-09-01 00:00:00

  • Percutaneous pelvic fixation using working portals in a circumferential pelvic antishock sheet.

    abstract::Unstable pelvic ring injuries are associated with an increased mortality rate, most commonly from severe hemorrhage. Circumferential pelvic antishock sheeting has proven effective for rapidly stabilizing the pelvic ring and has become an integral part of resuscitation protocols. Acute antishock sheet placement frequen...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0b013e3181a87c6c

    authors: Gardner MJ,Osgood G,Molnar R,Chip Routt ML Jr

    更新日期:2009-10-01 00:00:00

  • Assessment of Open Syndesmosis Reduction Techniques in an Unbroken Fibula Model: Visualization Versus Palpation.

    abstract:OBJECTIVES:This cadaveric study sought to evaluate the accuracy of syndesmotic reduction using direct visualization via an anterolateral approach compared with palpation of the syndesmosis through a laterally based incision. METHODS:Ten cadaveric specimens were obtained and underwent baseline computed tomography (CT) ...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000001322

    authors: Pang EQ,Coughlan M,Bonaretti S,Finlay A,Bellino M,Bishop JA,Gardner MJ

    更新日期:2019-01-01 00:00:00

  • Surgical exposure and fixation of displaced type IV, V, and VI glenoid fractures.

    abstract::Displaced intra-articular fractures of the glenoid are rare and frequently result from high-energy injuries. Types IV, V, and VI fractures have in common a fracture line which extends medially into the scapular body. These fracture patterns present unique challenges for surgical approaches and reduction and fixation s...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章,评审

    doi:10.1097/BOT.0b013e31817d5356

    authors: Nork SE,Barei DP,Gardner MJ,Schildhauer TA,Mayo KA,Benirschke SK

    更新日期:2008-08-01 00:00:00

  • Irreducible fracture dislocation of the knee.

    abstract::A unique case of an irreducible fracture dislocation of the knee is reported. A review of the literature revealed no previously reported cases of fracture dislocation of the distal femur not amenable to closed reduction. ...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章,评审

    doi:10.1097/00005131-199607000-00013

    authors: Pugh KJ,Wilber JH

    更新日期:1996-01-01 00:00:00

  • Open scapulothoracic dissociation with intact neurovascular status in a child.

    abstract::A case of open scapulothoracic dissociation with intact neurovascular status in an 8-year-old girl is reported. Scapulothoracic dissociation is a rare injury. Most cases present with significant soft tissue disruption in the shoulder region secondary to separation of the scapula from the thorax, and involve major vasc...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/00005131-198802000-00009

    authors: An HS,Vonderbrink JP,Ebraheim NA,Shiple F,Jackson WT

    更新日期:1988-01-01 00:00:00

  • Acute vascular injury associated with fracture of the distal radius: a report of 6 cases.

    abstract:OBJECTIVES:To highlight the potential for vascular injury with fracture of the distal radius. DESIGN:Retrospective case series. SETTING:The practices of several orthopaedic hand surgeons. PATIENTS/PARTICIPANTS:Six patients with arterial injury as a consequence of fracture of the distal radius: 2 partial lacerations ...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0b013e318188d686

    authors: de Witte PB,Lozano-Calderon S,Harness N,Watchmaker G,Green MS,Ring D

    更新日期:2008-10-01 00:00:00

  • Mechanical failure after locking plate fixation of unstable intertrochanteric femur fractures.

    abstract:OBJECTIVES:The aim of this study was analyze modes of mechanical failure in a consecutive cohort of patients and establish possible risk factors. DESIGN:This was a retrospective cohort study. SETTING:The study was conducted at an academic level-1 trauma center. PATIENTS:Twenty-nine patients (mean age 56 years, range...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0b013e318251930d

    authors: Streubel PN,Moustoukas MJ,Obremskey WT

    更新日期:2013-01-01 00:00:00

  • Trochanteric gamma nail and compression hip screw for trochanteric fractures: a randomized, prospective, comparative study in 210 elderly patients with a new design of the gamma nail.

    abstract:OBJECTIVES:To compare the results between a new intramedullary Gamma nail and a compression hip screw in the treatment of trochanteric fractures. DESIGN:Prospective randomized. SETTING:Level 1 trauma center. PATIENTS:Two hundred ten consecutive patients older than 65 years with trochanteric femoral fractures. INTER...

    journal_title:Journal of orthopaedic trauma

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/01.bot.0000151819.95075.ad

    authors: Utrilla AL,Reig JS,Muñoz FM,Tufanisco CB

    更新日期:2005-04-01 00:00:00

  • Convergent radioulnar translocation with radial head fracture in a child: a case report and review of the literature.

    abstract:SUMMARY:Convergent type radioulnar translocation is an extremely rare form of injury occurring in a growing child. We report a case of convergent radioulnar translocation along with a radial head fracture in a young child. Open reduction of the elbow and internal fixation of the radial head fragment helped in achieving...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章,评审

    doi:10.1097/BOT.0b013e31821d7fd5

    authors: Agashe MV,Samant A,Aroojis AJ

    更新日期:2012-04-01 00:00:00

  • Minimum 1-year follow-up for patients with vertical shear sacroiliac joint dislocations treated with iliosacral screws: does joint ankylosis or anatomic reduction contribute to functional outcome?

    abstract:OBJECTIVE:To prospectively analyze a homogenous group of trauma patients with pure sacroiliac (SI) joint dislocations treated with iliosacral screws (ISS), with specific attention to functional outcome and its correlation with the presence or absence of SI joint ankylosis and quality of reduction. DESIGN:Retrospective...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0b013e31816b6b4e

    authors: Mullis BH,Sagi HC

    更新日期:2008-05-01 00:00:00

  • Change over time of SF-36 functional outcomes for operatively treated unstable ankle fractures.

    abstract:OBJECTIVE:Ankle fractures are one of the most common operatively treated lower extremity fractures. Several studies indicate that patients often have residual effects after this injury. The purpose of this study is to use the SF-36 questionnaire at two times to assess patients' functional recovery and residual effects ...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/00005131-200201000-00007

    authors: Obremskey WT,Dirschl DR,Crowther JD,Craig WL 3rd,Driver RE,LeCroy CM

    更新日期:2002-01-01 00:00:00

  • Levels of Evidence in Orthopaedic Trauma Literature.

    abstract:OBJECTIVE:To review and critically assess trends observed regarding the levels of evidence in published articles in orthopaedic traumatology literature. DATA SOURCES:The Journal of Orthopaedic Trauma, Journal of Bone and Joint Surgery-American, and Clinical Orthopaedics and Related Research. STUDY SELECTION:All artic...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章,评审

    doi:10.1097/BOT.0000000000000557

    authors: Scheschuk JP,Mostello AJ,Lombardi NJ,Maltenfort MG,Freedman KB,Tjoumakaris FP

    更新日期:2016-07-01 00:00:00

  • Posteromedial Approach to Tibial Plateau Fracture Nonunion.

    abstract::Tibial plateau fractures can involve planes that require reduction and stabilization from a posterior approach. This includes posteromedial, posterolateral, and posterior column shear type injuries. This video outlines the prone posteromedial approach to the tibial plateau for posterior column fracture exposure, reduc...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000001826

    authors: Shields CN,Eftekhary N,Egol KA

    更新日期:2020-08-01 00:00:00

  • Plating of femoral neck fractures: when and how?

    abstract::Intracapsular femoral neck fractures are common in the elderly population after a simple fall. However, femoral neck fractures in the physiologically young are less common. Regardless, femoral neck fractures can be a source of significant morbidity and mortality if not treated correctly. Multiple management strategies...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000000288

    authors: Florschutz AV,Donegan DJ,Haidukewych G,Liporace FA

    更新日期:2015-04-01 00:00:00

  • Unstable proximal extraarticular tibia fractures: a biomechanical evaluation of four methods of fixation.

    abstract:OBJECTIVE:To compare the biomechanical stability of extraarticular proximal tibia fractures reconstructed using a double-plate construct, locking plate system, hybrid external fixator, and single lateral periarticular plate, all from the same manufacturer. DESIGN:Standardized proximal tibial fractures (AO classificati...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/00005131-200409000-00010

    authors: Peindl RD,Zura RD,Vincent A,Coley ER,Bosse MJ,Sims SH

    更新日期:2004-09-01 00:00:00

  • Comparison of Early Fatigue Failure of the TFNa and Gamma 3 Cephalomedullary Nails in the United States From 2015 to 2019.

    abstract:OBJECTIVES:To compare reports of implant fatigue failure submitted to the FDA of 2 commonly used cephalomedullary nails. METHODS:In total, 2724 medical device reports from the FDA's MAUDE database from Jan 2015 to Oct 2019 were reviewed for the Trochanteric Femoral Nail-Advanced (TFNa) and Gamma 3 implants. RESULTS:D...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000001864

    authors: Klima ML

    更新日期:2021-02-01 00:00:00

  • Incidence and fracture morphology of posterolateral fragments in lateral and bicondylar tibial plateau fractures.

    abstract:OBJECTIVES:This study aimed to evaluate the incidence and morphologic features of posterolateral fragments in lateral and bicondylar tibial plateau fractures. DESIGN:This study used retrospective chart and computed tomography (CT) reviews. SETTING:The study was conducted in a university hospital. PATIENTS:All patien...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000000170

    authors: Sohn HS,Yoon YC,Cho JW,Cho WT,Oh CW,Oh JK

    更新日期:2015-02-01 00:00:00

  • Posterior Wall Osteotomy of the Acetabulum to Access Incarcerated Marginal Impaction.

    abstract::Marginal impaction of the acetabulum is typically accessible through fracture planes specific to the nature of the injury. Infrequently, however, incarcerated marginal impaction or free osteochondral fragments are not accessible through these existing fracture planes. As such, alternative methods to access these artic...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000000759

    authors: Schroeder AJ,Avilucea FR,Archdeacon MT

    更新日期:2017-05-01 00:00:00

  • Inflammatory cytokine and chemokine expression is associated with heterotopic ossification in high-energy penetrating war injuries.

    abstract:OBJECTIVE:Heterotopic ossification (HO) develops frequently after modern high-energy penetrating war injuries. The purpose of this prospective study was to identify and characterize the unique cytokine and chemokine profile associated with the development of HO as it pertained to the systemic inflammatory response afte...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0b013e31825d60a5

    authors: Evans KN,Forsberg JA,Potter BK,Hawksworth JS,Brown TS,Andersen R,Dunne JR,Tadaki D,Elster EA

    更新日期:2012-11-01 00:00:00

  • A method for detection of lateral malleolar malrotation using conventional fluoroscopy.

    abstract::Recent studies on ankle syndesmosis injuries have shown that a significant amount of rotational malediction of the distal fibula are missed and may lead to poor functional outcome. A new set of radiographic criteria were developed to help detect distal fibula internal and external rotation using conventional fluorosco...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0b013e31828f89a9

    authors: Marmor M,Kandemir U,Matityahu A,Jergesen H,McClellan T,Morshed S

    更新日期:2013-12-01 00:00:00

  • A Machine Learning Algorithm to Predict the Probability of (Occult) Posterior Malleolar Fractures Associated With Tibial Shaft Fractures to Guide "Malleolus First" Fixation.

    abstract:OBJECTIVES:To develop an accurate machine learning (ML) predictive model incorporating patient, fracture, and trauma characteristics to identify individual patients at risk of an (occult) PMF. METHODS:Databases of 2 studies including patients with TSFs from 2 Level 1 trauma centers were combined for analysis. Using te...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000001663

    authors: Hendrickx LAM,Sobol GL,Langerhuizen DWG,Bulstra AEJ,Hreha J,Sprague S,Sirkin MS,Ring D,Kerkhoffs GMMJ,Jaarsma RL,Doornberg JN,Machine Learning Consortium.

    更新日期:2020-03-01 00:00:00

  • Operating Room Supply Costs in Orthopaedic Trauma: Cost Containment Opportunities.

    abstract::In the current health care environment, cost containment is more important than ever. Most physicians currently are unaware of the cost of operating room supplies. A large amount of waste occurs secondary to lack of knowledge and absence of physician incentives for cost saving. Many of the decisions for supply use can...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/BOT.0000000000000718

    authors: Gurnea TP,Frye WP,Althausen PL

    更新日期:2016-12-01 00:00:00

  • A new technique for creating an abdominal window in a hip spica cast.

    abstract::Opening an abdominal window in a hip spica type of cast can be a troubling maneuver for both orthopaedic surgeon and patient. We present a simple device to create an abdominal window more easily. ...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章

    doi:10.1097/00005131-200307000-00009

    authors: Kiter E,Demirkan F,Kiliç BA,Erkula G

    更新日期:2003-07-01 00:00:00