A view of the future Model Spinal Cord Injury System through the prism of past achievements and current challenges.

OBJECTIVE: To examine the contributions of the Model Spinal Cord Injury System (MSCIS) program to the evaluation and care of individuals with spinal cord injury (SCI) and to acknowledge today's challenges to chart the future course of the MSCIS. METHODS: Retrospective review of the literature and prospective development of consensus by task force members and consultants. Integration of recent reported findings from panel presentations and publications regarding the MSCIS 2000 through 2005. FINDINGS: Significant strides have been made toward the improvement of care for individuals with SCI, which can be attributed to the quality of clinical investigation and education. This has been achieved through the leadership of MSCIS directors in partnership with members from national and international voluntary organizations. These efforts include more than 2,000 peer-reviewed publications from the MSCIS, which have served as a basis for practice guidelines in the field. Although much has been accomplished with regard to reducing medical and behavioral complications, mortality, and length of stay in the hospital and increasing successful return to the community, more is needed. CONCLUSION: The MSCIS has a unique opportunity to provide solutions because of its world-renowned database and center, outcome measures, and infrastructure for trials. To maximize this opportunity, the MSCIS must continue to address the appropriate investigational and service issues by defining the best approach to data collection, rigorous clinical studies, and behavioral strategies in the next decade.

Factors associated with improved neurologic outcomes in patients with incomplete tetraplegia.

STUDY DESIGN: Retrospective review of 412 patients with traumatic, incomplete, cervical spinal cord injuries, and an average follow-up period of 2 years. OBJECTIVES: To determine what patient characteristics, injury variables, and management strategies are associated with improved neurologic outcomes. In particular, the effects of intravenous steroids (NASCIS II protocol), early definitive surgery (<24 hours after injury), early anterior decompression for burst fractures or disc herniations (<24 hours after injury), and surgical decompression for stenosis without fracture were assessed. SUMMARY OF BACKGROUND DATA: Controversy surrounds the pharmacologic and surgical management of patients with spinal cord injuries. METHODS: Neurologic data were collected retrospectively and classified using American Spinal Injury Association guidelines. This information was recorded at the time of injury, on admission to rehabilitation, on discharge from rehabilitation, and at 1, 2, and final year of follow-up evaluation. Outcome measures included change in motor score, change in sensory score, final motor score, and final sensory score. The SPSS v10.0.7 statistical software package was used for data analysis. RESULTS: Neurologic recovery was not related to the following factors: gender, race, type of fracture, or mechanism of injury. Neurologic recovery also was not related to the following interventions: high-dose methylprednisolone administration, early definitive surgery, early anterior decompression for burst fractures or disc herniations, or decompression of stenotic canals without fracture. Improved neurologic outcomes were, however, noted in younger patients ( = 0.002), and those with either a central cord or Brown-Sequard syndrome ( = 0.019). CONCLUSIONS: The most important prognostic variable relating to neurologic recovery in a patient with a spinal cord injury is the completeness of the lesion. When an incomplete cervical spinal cord lesion exists, younger patients and those with either a central cord or Brown-Sequard syndrome have a more favorable prognosis for recovery. In this study, no evidence was found to support high-dose steroid administration, routine early surgical intervention, or surgical decompression in stenotic patients without fracture.

Technology in the Management of Spinal Cord Injuries.

Injury to the spinal cord is catastrophic and usually permanent. Whereas other injured tissues, such as bone, skin, blood vessels and peripheral nerves, are capable of being repaired and resuming near normal function, such is not the case with the spinal cord. Thus far, all attempts to repair the cord using every conceivable technique has ended in failure. The physician and other members of the treatment team involved with a patient with spinal cord injury, must deal with permanent, long-term consequences of the injury.

Professional Basketball Injuries.

In brief In a ten-year study of 70 professional basketball players, 47 sustained 265 injuries that most frequently occurred during early-season games. Centers, who had the highest injury rate, most frequently injured their backs; guards most frequently injured elbows and knees; and forwards most often injured fingers and knees. Strains and sprains were the most common problems. Most injuries resulted from trauma rather than from training or conditioning errors.