ABSTRACT
BACKGROUND: The proper timing for surgery in patients with acute spinal cord injury is controversial. This study was conducted to detect if there is an advantage in early (within the first 4 hours after trauma) compared to late (between 4 and 24 hours after trauma) surgery on neurological outcome. METHODS: In this single institution prospective cohort study, data were analyzed from 51 spinal cord injured patients with an average age of 43.4 (±19.2) years. The influence of early (29 patients within the first 4 hours) as opposed to late (22 patients between 4 and 24 hours) decompression was evaluated by comparing data for neurological outcome. Patients of the study collectively suffered acute spinal fractures from C2 to L3 (cervical 39.2%, thoracic 29.4%, and lumbal 21.6%) or nonosseous lesions (9.8%). American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades were assessed at time of admission and 6 months after trauma or longer depending on the time of release. Surgical treatment included early stabilization and decompression within 24 hours. RESULTS: No significant difference between improved neurological function, measured with the AIS, and an early or late surgery time can be seen (P=0.402). Furthermore, binary logistic regression shows no significant difference between sex or age, and AIS improvement as possible confounders. CONCLUSION: In our study, all patients with spinal cord injury were treated with spine stabilization and decompression within the first 24 hours after trauma. Surgical decompression within the first 4 hours after trauma was not associated with improved neurological outcome compared to treatment between 4 and 24 hours. In a clinical context, this indicates that there is a time frame of at least 1 day in which optimal care is possible.
ABSTRACT
OBJECTIVES: To determine the effectiveness of platelet-rich plasma (PRP) in the treatment of nonhealing fistula in spinal cord-injured patients. STUDY DESIGN: This was a pilot study of 15 spinal cord-injured patients with chronic pressure ulcers (PrUs) and nonhealing fistulas treated with PRP. SETTING: Germany, Rheinland Pfalz, BG Trauma Center Ludwigshafen METHODS: The authors treated 15 patients with PRP who had nonhealing fistulas due to multiple surgical closures of PrUs. According to the National Pressure Ulcer Advisory Panel's stages, 12 patients had Stage III PrUs, and 3 patients had Stage IV PrUs. RESULTS: After 1 week of treatment with PRP, the authors observed low levels of secretion from the fistulas. After 2 weeks, they noted no further secretion from the fistulas. A magnetic resonance imaging control investigation after 3 weeks showed the complete disappearance of the fistulas. No negative effects and no allergic reactions were noted in the use of PRP. CONCLUSION: The authors' results suggest that the application of PRP in combination with debridement is an effective therapy option and good alternative to recurrent surgical interventions for treating nonhealing fistulas resulting from the surgical closure of PrUs.
Subject(s)
Debridement/methods , Fistula/therapy , Platelet-Rich Plasma , Pressure Ulcer/therapy , Spinal Cord Injuries/complications , Wound Healing/physiology , Adult , Aged , Cohort Studies , Combined Modality Therapy , Female , Fistula/etiology , Fistula/physiopathology , Germany , Humans , Male , Middle Aged , Pilot Projects , Postoperative Complications/physiopathology , Postoperative Complications/therapy , Pressure Ulcer/etiology , Pressure Ulcer/physiopathology , Risk Assessment , Spinal Cord Injuries/diagnosis , Spinal Cord Injuries/surgery , Treatment OutcomeABSTRACT
OBJECTIVE: To determine serum concentrations of soluble CD95 ligand (sCD95L) in patients with traumatic spinal cord injury. METHODS: Patients with traumatic spinal cord injury were recruited. Blood was collected on admission to hospital and at 4 h, 9 h, 12 h, 24 h, 3 days, 7 days, and 2, 4, 8 and 12 weeks postadmission. Serum concentrations of sCD95L were determined via immunoassay. RESULT: The study included 23 patients. Mean sCD95L concentrations were significantly lower at 4 h, 9 h, 12 h and 24 h than at admission, and were significantly higher at 8 and 12 weeks, compared with admission. CONCLUSION: The serum sCD95L concentration fell significantly during the first 24 h after traumatic spinal cord injury. Concentrations then rose, becoming significantly higher than admission levels at 8 weeks. sCD95L may represent a possible therapeutic target for traumatic spinal cord injury.
