ACUTE SPINAL CORD INJURY

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ACUTE SPINAL CORD INJURY

• Thomas Balazy, M.D.
• CNS Medical Group, PC
• Medical Director, Craig Hospital
• Englewood, Colorado

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CNS Medical Group - Doctors average 17 years at
Craig
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Main Issue with SCI

• Motor/Sensory loss below the level of injury
  (LOI)
• Hyper reflex phenomenon after initial shock (CNS
  is no longer under control of supra-segmental/Brai
  n/Brainstem influences.)

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The Injury ______________________________________
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• Encloses the spinal cord
• Consists of 33 vertebrae
• . 7 cervical
• . 12 thoracic
• . 5 lumbar
• . 5 sacral
• . 4 coccygeal

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Fracture dislocation
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ASIA LEVELS
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Outcome determined by

• Initial damage to cord
• Blood flow compromise to injured tissue (enhanced
  neuro-recovery when MAP above 85 mm/Hg)
• Maximize activity/mobilization for cellular
  health.
• Maximize mental health for cellular health.
• Individual genetic make-up influencing healing.

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Prognosis for Neurological Recovery

• Motor Level Recovery
• Individuals with tetraplegia evaluated in the
  first month after injury should be expected to
  gain a motor level of function.
• Overall Recovery
• Neurological recovery is most rapid in the first
  few months after injury, slows by six months
  (Waters 1994a Waters 1994b), but may continue
  for two years or longer. (Ditunno 1992 Piepmeier
  1998)
• At the group level, for those with incomplete
  injuries, one-half to two-thirds of the one-year
  motor recovery occurs within the first two months
  after injury. (Bracken 1993 Bracken 1997
  Geisler 1991)

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Prognosis for Neurological Recovery

• Ambulation Potential
• Based upon neurological assessment within the
  first week of injury, 80 to 90 of those with
  complete injuries (ASIA A) will remain complete.
• Of those that convert to incomplete injuries,
  only 3-6 will recover functional strength in the
  lower extremities. (Ditunno 1995 Maynard 1979)
• Sensory Incomplete, Motor Complete (ASIA B)
• Comprise about 10 of all new injures
• Overall, approximately 50 of those who are
  initially classified as ASIA B will become
  ambulatory. (Maynard 1979).

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Prognosis for Neurological Recovery

• Motor Incomplete
• While not invariable, the majority of individuals
  with motor incomplete injuries recover the
  ability to ambulate.
• For individuals with motor incomplete injuries,
  about 75 will become community ambulators.
  (Waters 1994 Curt 1997 Roth 1990, Burns 1997)
• Age and the amount of preserved spinal cord
  function below the lesion influence recovery of
  ambulation. Prognosis is poor if less than 20 of
  function is preserved.

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Prognosis for Neurological Recovery

• Motor Incomplete continued
• Prognosis is good if more than 60 of function is
  preserved. (Daverat 1988)
• Prognosis is excellent for those initially
  classified as ASIA Impairment Scale D.
• Younger individuals have a better prognosis for
  ambulation with a similar injury severity.
• Prognosis for ambulation is poorer in those above
  50-60 years of age.
• (Waters 1994, Daverat 1988, Penrod 1990, Burns
  1997)

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Psycho-social
The negative effect of sadness, grief, depression
in cell health.
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Benefits of a Craig-Type Specialty Center

• Experience and numbers
• Other patient/family milieu with sharing of
  experiences
• Single Physician Management
• On Site CM for patient/family conference
• Expedite equipment approvals and home preparation
• Support adequate LOS

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Questions?Thank you!
Thomas Balazy MD 303-789-8220
tbalazy_at_craighospital.org