Neurological recovery and its prognostic indicators following traumatic spinal cord injuries

Title : Neurological recovery and its prognostic indicators following traumatic spinal cord injuries

Abstract:

Fortunately the incidence of Traumatic Spinal Cord Injury (TSCI) is rare 10-50/million population/year. Trauma to the spinal cord however results in a multi-system physiological impairment and malfunction, paralysis, sensory loss and a potential wide range of medical and non-medical complications. The injured spinal cord is Physiologically Unstable and can also be further damaged by non-mechanical insults. Hypoxia, hypertension, hypotension, sepsis, hypothermia, fluid overload can, with inadequate management are insults that can easily occur and cause more damage to the injured cord that result neurological deterioration, lack of recovery or delay in recovery. A physiological approach with scrupulous simultaneous attention to the spinal injury and all the medical effects of cord damage Guttmann in the 2ndWW demonstrated that all complications can be prevented, a good and painless range of movement of the spine can be achieved,further neurological damage can be prevented. He also realised that the non-medical effects of cord damage can be equally devastating for the patients and if not given the same attention they can affect the medical and rehabilitation outcomes. With a holistic management from the early hours or days of injury Guttman and the clinicians who were able to offer this model of service delivery in the last seventy years demonstrated that patients with complete cord damage become able to live enjoyable long dignified fulfilling productive and often competitive lives with safe and convenient functioning of all their body systems. They also demonstrated that patients with sensory sparing made significant motor recovery and most patients with long tract sensory sparing ecovered ambulation irrespective of the radiological appearance on presentation and without intervention on the injured spine. From the mid-eighties onward the development of CT and MRI; improved instrumentation & increased safety of anaesthetic resulted in a change of practice from Active Physiological Conservative Management (APCM) of the spinal injury and all its effects to a Focused Surgical Stabilisation or Decompression or both. The rationale is to mechanically realign and stabilise the spine and/or decompress the spinal cord in the hope of preventing further neurological damage, achieving early mobilisation and rehabilitation and reducing cost of treatment. The significance of the BI, Canal encroachment and Traumatic Cord Compression as well as the possible advantages, disadvantages, complications of Surgical Stabilisation, Surgical Decompression and APCM will be discussed . The arguments for Surgical vs Active Physiological Conservative Management of the injured spine and effects of cord damage and their outcomes will be discussed. The importance of some future areas of research will be highlighted.

Biography:

WEM trained in the speciality of spinal injuries at Stoke Mandeville, Oxford, Guys Hospitals & the USA between 1971 and 1983 . To date he personally treated 10,000 patients with traumatic Spinal Injuries. WEM developed, and led the Midland Centre for Spinal Injuries (MCSI) between 1983 & 2014. He took  responsibility for the management of the injured spine, the multisystem malfunction as well as the range of non-medical and physical effects of cord injury in the acute, subacute, rehabilitation phases as well as in the long term. WEM lectured worldwide in developed and developing countries. He contributed to the  literature with over 140 publications. He published his observations on the prognostic indicators of neurological recovery following Traumatic Spinal Cord Injuries and Introduced the concept of “Physiological Instability of the Injured Spinal Cord ” and its influence on clinical management. WEM demonstrated that with simultaneous Active Physiological Conservative Management of all the physiologically impaired and malfunctioning systems of the body together with the injured spine neurological recovery occurs in the majority of patients irrespective of the degree of Biomechanical Instability, Canal encroachment or Cord Compression. He is Peer reviewer and on the Editorial Boards of a number of Journals. WEM held the offices of: President of the International Spinal Cord Society, Chairman of the British Association of Spinal Cord Injury Specialists and Executive Member of the BSRM. Founder Member and trustee of a number of charities that support Health Care professionals and patients. Raised about six million pounds from charity to rebuild and furnish the MCSI. Advisor to WHO‘s International Perspectives on Spinal Cord Injury which was published in 2013. Member of the NICE Guideline Developing Group in spinal injuries. He received a number of awards including: the Medal of the International Spinal Cord Society, National Hospital Doctor Team Award for Innovation, Outstanding achievement award from the Chinese Society of Spinal Injuries, Outstanding Consultant Achievement award by the Spinal Injury Association, Hon. Presidency of the Romanian Spinal Cord Society, the Paul Harris Fellowship of the Rotary Club. WEM‘s concepts and support for evidence based clinical management including the right of the patient to make a fully informed choice between the various methods of management including the injured spine; the importance of management in a spinal injury centre with a fit for purpose infrastructure that enables all medical and non-medical needs of the patient to be met can be  accessed free of charge in the following publication in the journal.