Spinal Cord Injury: Current and Novel Treatment Strategies

INTRODUCTION The care and treatment of spinal cord injury (SCI) patients has significantly evolved over the last several decades. There has been great interest and promising research conducted over this period resulting in advancement of our understanding of the pathophysiology of SCI on both a biochemical and biomolecular level. Concurrently, there has also been rapid clinical advancements in treating spinal fractures with improvement in the understanding of the biomechanics of injuries, as well as improvements in spinal fixation techniques and devices. In addition, there have been great strides made in the collaborative care and treatment efforts of SCI patients particularly in the fields of radiology, rehabilitation, trauma, and intensive care. The developments in SCI treatment have led to a decrease in the overall incidence of traumatic injuries, particularly in the younger populations. This is mainly a result of preventative measures and education by the various foundations who focus on the treatment of SCI patients such as CSRS, ASIA, AAOS, CNS, and AANS. In addition, there has been a greater emphasis in society on limiting catastrophic injuries such as through the use of: airbag immobilization in motor vehicles, helmets, and the overall reduction of high-risk activities. To provide some background information on the pathophysiology of a traumatic SCI, it is believed that SCI is multifaceted, with the initial force or compression of the cord resulting in the primary injury. This is then followed by an inflammatory or biochemical response that results in further injury to the cord over the subsequent days to weeks. This is referred to as the secondary injury, and it is this stage of injury that has been the target of intense research. Currently, there exists multiple novel strategies in dealing with this secondary injury component including surgical techniques, medical management, pharmacology, and cell-based therapies which will be discussed below

Repeat Neuro-Imaging in Patients Presenting with Traumatic Extra-Axial Intracranial Hemorrhage

Introduction: The management of extra-axial intracranial hemorrhage patients is complicated and lacks a systemic algorithm to determine the timing and necessity of head computed tomography (HCT). However, repeat HCTs weakly predict the need for an intervention after mild traumatic brain injury (TBI). Objective: This study focused on assessing the safety, efficacy, and necessity of obtaining serial HCTs in patients presenting with subdural hemorrhages. Methods: A retrospective chart review was conducted of patients with subdural hemorrhages and a GCS between 13-15 on admission (n=116). The total number of HCTs, time between repeat HCTs, duration of hospital stay, and factors necessitating surgery were studied. Fischer’s exact was used to evaluate the association between 1 HCT or 2-3 HCTs and the need for surgical intervention. Results: There was no statistical difference found in the need for an intervention between patients having one or greater than one HCT in the first 24 hours. The average age was 69 years old. The gender breakdown comprised of 49 females and 67 males. 80% (n = 93) of the patients did not require surgery during hospital stay. Discussion: Our results suggest that there is no association found between the number of HCTs and surgical intervention. This study demonstrates the need for improved variables to assess TBI. We recognize the limitations found in this study and future analysis will need to assess other prognostic indicators to better predict the need for intervention in mild TBI patients

Improving Patient Safety Through A Postoperative Debriefing Initiative

Aims for Improvement Effective and clear communication in the operating room is a necessary aspect of any surgery. Every member of the operative team is integral in fostering an environment focused on patient safety. As such, the institution of a postoperative debrief session may allow for feedback from every member of the team that will ultimately aid in improving a patient’s experience