This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by El Masri(y), W. Search for Related Content Social Bookmarking                         What's this?

Traumatic spinal cord injury: the relationship between pathology and clinical implications

Midlands Centre for Spinal Injuries The Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, UK, Waghi.ElMasri{at}rjah.nhs.uk

The pathological effects of traumatic spinal cord injuries (SCI) encompass the pathology affecting the spinal cord. As a result of the interruption of spinal cord conduction, one or more pathological and patho-physiological processes affect almost every system of the human body. Knowledge of the pathological processes that affect the spinal cord and the various systems of the body is essential for the safe and good management of these patients. The small incidence (10-15 per million per year) of these highly complex conditions makes it difficult for skills and experience to develop in District General Hospitals in the management of these patients. The associated sensory impairment or loss present diagnostic challenges to the clinician in almost every aspect of paralysis and throughout the patient’s life.

In the acute stage simultaneous good management of the multi-system impairments and malfunctions giving equal attention to all systems including that of the traumatized spine is the key to good quality outcome. Concentrating resources at any one time on any one particular aspect of paralysis is unlikely to yield a similarly good outcome. The neurological outcome does not depend only on the quality of the management of the SCI. The traumatized physiologically unstable spinal cord is vulnerable and unable to protect itself from non-mechanical complications outside the spinal canal, many of which can easily develop in patients with SCI adding to the threats from the biomechanical instability.

To date there are many controversies in the management of many aspects of paralysis at all stages following injury. One of the main current controversies is in the management of the SCI itself. There are many reasons that seem to perpetuate this controversy. Some of the reasons may be related to different interpretations of the pathological processes that affect the vertebral axis and the spinal cord as well as their effects on neurological outcome. The natural history of neurological recovery following SCI is not always duly acknowledged.

Key Words: clinical implications • pathology • traumatic spinal cord injury

Trauma, Vol. 8, No. 1, 29-46 (2006)
DOI: 10.1191/1460408606ta357oa


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?