Traumatic Spinal Cord Injuries (tSCI) - Are the radiologically based “advances” in the management of the injured spine evidence-based?

Title : Traumatic Spinal Cord Injuries (tSCI) - Are the radiologically based “advances” in the management of the injured spine evidence-based?

Abstract:

Prior to WWII the majority patients with tSCI died in hospitals. There was however no shortage of Clinicians experimenting with the management of the injured spine. During WWII L. Guttmann (a well-trained aggressive Neurosurgeon) was given the task of looking after injured soldiers & officers with tSCI at Stoke Mandeville Hospital in the UK. By studying the condition and the causes of death in a large number of patients, he realised that patients died or developed further neurological damage from various complications caused by the multi-organ Physiological impairment and malfunction caused by the neural tissue injury and not from the Spinal Injury (SI). Some died because of additional complications from surgical interventions on the injured spine.

By providing a Holistic Model of Service Delivery that attends to all the patho-physiological medical and non-medical effects of cord damage as well as the injured spine by what can be described as Active Physiological Conservative Management (APCM) , Guttmann demonstrated that all complications can be prevented or diagnosed and treated early, some patients exhibit various degrees of neurological recovery and the great majority of patients can live long, healthy, dignified, productive and often competitive lives.

In 1967 Frankel et al studied the neurological outcome of 612 patients treated by APCM and demonstrated that the majority of patients who retained sensory sparing but had no visible or palpable motor sparing following the injury exhibited the recovery of motor power from the motor neurone adjacent to the spared sensory tracts. Surprisingly they found that the neurological recovery occurred irrespective of the radiological presentation on Xrays at admission (within 15 days of injury) and on discharge. They published their results in 1969 in what has been known since as the Frankel Classification. This was the first population outcome study that correlated the presentation and outcomes of patients presenting with sensory and sensory-motor sparing. Their findings have been confirmed by various international groups of clinicians dedicated to the management of patients with tSCI.

Prof El Masri will discuss the change of both the methods of management and model of service delivery to patients with tSCI following the development of CT and MRI. He will also discuss Rationale and Outcomes of each of these changes and the evidence of each of the methods of management of the injured spine in the presence of neural damage.

Biography:

Prof W S El Masri FRCS Ed; FRCP. Clinical Professor of Spinal Injuries - Keele University, Consultant Spinal Injuries – Hunters Moor Neurorehabilitation Centre Birmingham, Emeritus Consultant Surgeon in Spinal Injuries Robert Jones and Agnes Hunt Orth.Hospital Trained in the speciality of spinal injuries at Stoke Mandeville, Oxford, Guys Hospitals & the USA between 1971 and 1983 . To date personally treated 10,000 patients with traumatic Spinal and spinal cord Injuries. Developed, and led the Midland Centre for Spinal Injuries (MCSI) between 1983 & 2014. Took responsibility for the management of the injured spine, the multisystem malfunction as well as the range of medical, non-medical and physical effects of cord injury in the acute, subacute, rehabilitation phases as well as in the long term. Lectured worldwide in developed and developing countries. Contributed to the literature with 140 publications. Documented the prognostic indicators of neurological recovery following Traumatic Spinal Cord Injuries. Demonstrated that with simultaneous Active Physiological Conservative Management of the injury and all its medical effects neurological recovery occurs irrespective of the degree of Biomechanical Instability, Canal encroachment or Cord Compression. Introduced the concept of “Physiological Instability of the Injured Spinal Cord” Peer reviewer and on the Editorial Boards of a number of Journals Held the offices of: President of the International Spinal Cord Society, Chairman of the British Association of Spinal Cord Injury Specialists, Executive Member of the British Society of Rehabilitation Medicine . 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. Obtained 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 and the prestigious Paul Harris Fellowship of the Rotary Club.