Epidemiology of cervical spine abnormalities in asymptomatic adult professional rugby union players using static and dynamic MRI protocols: 2002 to 2006.

OBJECTIVE: In this study, the prevalence of abnormalities in the cervical spine of asymptomatic professional rugby players using both static and dynamic magnetic resonance imaging (MRI) in order to improve the detection of abnormalities and prevention of related injuries was investigated. DESIGN: Prospective observational study. SETTING: French professional rugby union clubs, between 2002 and 2006. PARTICIPANTS: 206 elite male adult players. INTERVENTION: Static sagittal T2 and axial T2* fast spin echo (FSE), and dynamic sagittal single-shot FSE weighted MRI scans of the C2-C7 region were examined for the presence of abnormalities. Participants' spines were in supine neutral position for the static protocol but were allowed complete flexibility in a sagittal plane for the dynamic protocol. MAIN OUTCOME MEASUREMENTS: The medulla-to-canal ratio (MCR) was measured at every vertebral disc level for both MRI methods. When observed, anatomical abnormalities were categorised. RESULTS: Anatomical abnormalities mainly consisted of degenerative discopathy and were most frequently observed in players aged>21 years, as well as in players whose MCR was abnormally high based on medical expertise. Most MCRs that were initially assessed as intermediate with static MRI were subsequently assessed as abnormal with dynamic MRI assessment. CONCLUSIONS: Since dynamic MRI is more accurate than static techniques in examining the cervical spine, it contributes substantially to identifying the risk of spinal injuries in professional rugby players, and when used in association with clinical assessment, it can assist in preventing spinal injury.

Causes of death after spinal cord injury.

STUDY DESIGN: Mortality review was undertaken of patients who suffered traumatic spinal cord injury (SCI) between 1955 and 1994 inclusive. OBJECTIVES: The study objective was to provide evidence of reasons for the observed reduction in long-term life expectancy for the SCI population. SETTING: Patients were those who had most, if not all, of their inpatient and outpatient care at Royal North Shore Hospital, Spinal Injuries Unit, Sydney, New South Wales, Australia. METHODS: Data on causes of death for 195 patients fitting the inclusion criteria were analysed by actuarial methods using ICD9CM classifications. RESULTS: The incidence of death in the spinal cord injured, from septicaemia, pneumonia and influenza, diseases of the urinary uystem and suicide, are significantly higher than in the general population. The findings confirm variations in potentially treatable causes of death depending on neurological impairment, attained age and duration since injury. Unlike septicaemia and pneumonia, which have shown a significant reduction since 1980, the death rate for suicide alone has risen. CONCLUSION: This analysis identified complications which affect mortality and morbidity in patients suffering from the effects of SCI.

Mortality following spinal cord injury.

This study analyzed the mortality in 1453 spinal cord injured patients admitted early after injury to a specialised Spinal Injuries Unit within a University teaching hospital over a 40-year period. The cohort comprised 55.3% patients with cervical lesions and 44.7% patients with thoracic/lumbar lesions. Those patients who died within 18 months of the spinal injury (132) were excluded from the final analysis. Standardised Mortality Ratios, survival rates and life expectancy ratios were calculated for specific ranges of current attained age and duration since injury with reference to level and degree of spinal cord injury. The projected mean life expectancy of spinal cord injured people compared to that of the whole population was then estimated to approach 70% of normal for individuals with complete tetraplegia and 84% of normal for complete paraplegia (Frankel grade A). Patients with an incomplete lesion and motor functional capabilities (Frankel grade D) are projected to have a life expectancy of at least 92% of the normal population.

Clinical evaluation of a new orthosis, the 'walkabout', for restoration of functional standing and short distance mobility in spinal paralysed individuals.

The Walkabout orthosis is a relatively new device for assisted standing and mobility in spinal paralysed individuals. The design, with a medially-mounted single-axis hinge joint linking two knee-ankle-foot orthoses, is quite different to other currently available orthoses which have laterally positioned hip joints such as the Reciprocal Gait Orthosis or Hip Guidance Orthosis. Twenty-five spinal cord injured patients were fitted and trained with the Walkabout orthosis and followed up regularly for just under 2 years on average. Sixty percent of all the patients fitted have incorporated use of the Walkabout orthosis into their lifestyles. Maintenance of joint mobility and psychological benefits were the most important outcomes of Walkabout usage. Loss of thoraco-lumbar mobility was found to be a limiting factor in successful use of the Walkabout orthosis in patients without active hip flexion. Patient selection criteria should include demonstrated spinal stability without significant deformity, controlled muscle spasm, less than 5 degrees of hip or knee flexion contracture, achievable neutral ankle position, mobility of the thoraco-lumbar spine into lateral flexion, good upper limb strength, and motivation with realistic expectations.

Prevention of spinal cord injuries in an Australian study (New South Wales).

The Spinal Awareness and Prevention Programme presented through the Royal North Shore Hospital and the Royal Rehabilitation Centre, in Sydney, NSW, Australia has grown considerably since 1982. Ten years later it is pleasing to report that the programme has grown in response to public demand and requires a full time coordinator, secretary and five disabled lecturers (part time). This prevention message now reaches over 100,000 school students throughout New South Wales every year as well as the community in general through media advertising. Over the last 5 years the annual incidence of spinal cord injury has dropped by 20% in New South Wales for motor vehicle accidents, contact sport and water related accidents. The 'lifetime' costs for paraplegia approach AUS$1,000,000 and for quadriplegia AUS$2,000,000. The reduction of serious spinal injuries means that at least 20 families in this State, with a population of nearly 6 million, will not this year have to face the tragedy and enormous challenge of permanent paralysis. There is now commitment to the promotion of prevention of spinal cord injuries. The annual cost of this programme to each individual in the community is less than 10 cents.

Tiger mauling: fatal spinal injury.

A 33 year old zoo keeper was attacked by a Sumatran tiger in captivity. Apart from severe lacerations and penetrating wounds to the head and neck, the patient sustained comminuted fractures of C1 and C2 vertebrae with resultant high laceration of the spinal cord. Major vascular injury as well as trauma to pharynx also occurred. The patient survived these injuries for 15 h.

Prevention of spinal cord injuries in Australia.

An Awareness and Prevention Team of five lecturers has been employed for 5 years funded by the Spinal Research Foundation at the Royal North Shore Hospital of Sydney, New South Wales. An evaluation of the effectiveness of the lecture programme in increasing knowledge and preventing the incidence of spinal cord injury was carried out to demonstrate the justification for continuing the Programme. This evaluation was achieved using a questionnaire designed for sample responses by school students in target age range. The questionnaires were distributed to 27 schools in five categories in order to obtain a spread of responses and a workable control group of schools which had not been visited by the Team. Results of 3823 questionnaires were tabulated and analysed by computer. The schools which had been visited by the Lecture Team showed both higher levels of knowledge on the structure of the spinal cord and effects of injury and also a more balanced attitude and awareness towards people requiring wheelchairs for mobility.

Arterial Brown-Séquard's syndrome after a penetrating injury of the spinal cord at the cervicomedullary junction.

A case of a 12-year-old boy, in whom a partial Brown-Séquard's syndrome developed after a gunshot injury to the back of the neck, is reported. The bullet, which was removed at operation, penetrated the left side of the spinal cord at the cervicomedullary junction. The patient recovered useful function in his left leg within a month after the injury, and was able to walk with the aid of a crutch on discharge from hospital. The case is unusual, because of the survival and subsequent good recovery of the patient after a high, penetrating injury of the spinal cord.

Effects of a contusion injury on spinal cord blood flow in the sheep.

The effect of experimental trauma on the blood flow in the central (essentially gray matter) and peripheral (essentially white matter) regions of the sheep's spinal cord was studied using a radioactive microsphere technique. In seven out of eight animals, a progressive fall in blood flow occurred in both the peripheral and central regions of the cord within 2 hours following injury and remained reduced over the period of recording (up to 12 hours). Changes in local vascular resistance indicated that in approximately 60% of our animals, changes in arterial pressure alone contributed highly significantly to the decreased spinal blood flow. There remains the possibility that early therapeutic intervention could sustain neuronal function where local blood flow would otherwise be inadequate in the damaged spinal cord.

The use of hyperbaric oxygen to modify the effects of recent contusion injury to the spinal cord.

Studies on the experimental spinal contusion injury in animals confirm that posttraumatic ischemia contributes to central cystic necrosis or fibrosis occurring at the level of the spinal cord lesion. Hyperbaric oxygen (HBO) modifies the degree and extent of the pathology in the spinal cord of the experimental animals. HBO has been used for 45 patients with recent spinal cord injuries. The extent of recovery in 27 patients with upper motor neuron lesions treated with adequate HBO is reported. Fifteen of the 27 patients had useful functional recovery.

Low cost wheelchair.

This wheelchair is a new concept in wheelchair design, made entirely of readily available plastic materials and rear bicycle wheels. The chair does not require a cushion, weights only 12 kg with 100 mm front castors or 13 kg with 175 mm castors. It is easy to manoeuvre. The design allows this wheelchair to be used as a conventional wheelchair and a shower/commode chair. Side arms and brakes can be attached if required. The necessary materials are relatively inexpensive and generally available in most countries.

Spinal trauma: pharmacological evidence for vasoconstrictor activity in cerebrospinal fluid.

Cerebrospinal fluid from six cases of acute spinal trauma collected 0--6 days after injury was examined for vasoconstrictor activity using both human isolated cerebral arteries and animal tissues. The cerebrospinal fluid of four out of six patients was vasoactive. The identities of the vasoconstrictor substances were not established, but experiments with pharmacological antagonists showed that arterial contractions were not due to serotonin, histamine, noradrenaline, acetylcholine or angiotensin II, substances which are known potent spastic agents on cerebral arteries. Our findings would explain by the mechanism of arterial spasm, principally in the anterior spinal artery, the neuropathological appearance of central haemorrhagic necrosis in spinal cord injury. The infarction of the core of the spinal cord could be caused by vasoconstrictor substances, reported here, in the cerebrospinal fluid after spinal injury. If the identities of the substances could be established, drug therapy to prevent or relieve the spasm would be possible.

Effects of anesthesia and laminectomy on regional spinal cord blood flow in conscious sheep.

Blood flow for the whole spinal cord (SCBF), central cord (largely gray matter), and peripheral cord (largely white matter) has been measured at all segmental levels using radioactive microspheres in conscious sheep. Whole SCBF was greatest in the lower cervical and lumbar enlargements and least in the upper cervical and thoracic regions. This was attributable partly to regional variations in gray-matter blood flow but principally to regional variations in the proportion of gray and white matter present. Whole SCBF for the total cord was 14.5 +/- 0.8 ml/100 gm/min, central cord flow was 40.6 +/- 3.5 ml/100 gm/min, and peripheral cord flow was 9.7 +/- 1.9 ml/100 gm/min. Blood flow was not affected by sodium pentobarbital provided the level of anesthesia, arterial pressure, and blood gases was carefully regulated. Laminectomy usually resulted in a marked increase in central cord blood flow at the site of cord exposure, lasting about 90 minutes; this increase was not necessarily reflected in whole SCBF because of the absence of any change in blood flow in the relatively large proportion of peripheral cord. This effect of laminectomy could adversely influence results obtained from studies using invasive techniques to measure SCBF.

Monoamine and tissue fluid levels in contused spinal cord of sheep.

Methods are described for the determination of sheep spinal cord tissue fluid content and norepinephrine, serotonin, and dopamine concentrations after experimental injury. The amount of tissue fluid varied in different regions of sheep spinal cord following injury. Norepinephrine and serotonin wet weight concentrations were corrected for this variation in tissue fluid. Corrected norepinephrine wet weight cord concentrations did not change up to 3 hr after injury. Levels of serotonin at 60 min after injury were similar to controls. Dopamine was not detected in sheep spinal cord. alpha-Methyl tyrosine significantly reduced fluid in the spinal cord at 75 min after injury.

Five-year review of spinal cord injuries in motorcyclists.

One hundred and twenty motorcyclists with significant spinal cord injuries, who were admitted to hospital over a five-year period, have been reviewed. Fifty-one per cent of them suffered direct injuries to the vertebral column and spinal cord, the majority remaining permanently paraplegic. Thirteen of the 25 riders who became tetraplegic were wearing open-face helmets, and 11 of these remained permanently paralysed. The survey suggests that the open-face helmet offers less protection to the cervical spinal cord than the full-face helmet. There is an urgent need to review standards for the design of helmets worn by motorcyclists.