spinal cord injury - cumming.ucalgary.ca · spinal cord injury epidemiology and pathophysiology...
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![Page 1: Spinal Cord Injury - cumming.ucalgary.ca · Spinal Cord Injury Epidemiology and Pathophysiology Forrest Hsu and Dr. Hurlbert University of Calgary Neurosurgery Halfday February 05,](https://reader033.vdocument.in/reader033/viewer/2022053006/5f09fb837e708231d429715b/html5/thumbnails/1.jpg)
Spinal Cord InjuryEpidemiology and Pathophysiology
Forrest Hsu and Dr. HurlbertUniversity of Calgary Neurosurgery Halfday February 05, 2008
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Acute SCI Epidemiology
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Acute SCI prevalent among the young
55% Age < 30yrs 80-85% are male
10%
10%
10%
15%25%
20%
10%Birth-10y
11-20y
21-30y31-40y
41-50y
>60y
adapted from Sekhon et al. Spine 26(24s)S2-S12, 2001.
51-60y
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60-70% of all SCI are traffic accidents and falls
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Acute SCI are predominantly cervical fracture dislocations
adapted from Sekhon et al. Spine 26(24s)S2-S12, 2001.
15%
15%
15%
55%Cervical
Thoracic
Thoracolumbar
Lumbosacral10%
5%
30%
5%
40%
10%Minor #
#/Dislocation
Dislocation
Burst #
SCIWORA
SCIWORET
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Incomplete SCI are most common
Complete SCI are more likely Thoracic > Cervical or Lumbar injuriesPotential for Recovery from Complete SCI: Cervical > Thoracic > Lumbar
adapted from Sekhon et al. Spine 26(24s)S2-S12, 2001.
30%
10%
15%
45%ASIA A
ASIA B
ASIA C
ASIA D
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Acute SCI Pathophysiology
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The Cascade of Acute Spinal Cord InjurySonntag et al. Rothman-Simeone the Spine 2005.
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Mechanisms of Primary SCI
Impact w/ persistent compression
Burst # w/ canal compromise#/Dislocationacute disc rupturesmost common SCI (young, high nrg)
Impact w/ transient compression
hyperextension w/ underlying spondylosiscentral cord syndrome2nd most common (older, low nrg)
Distraction
stretch/shear injury of cord and vascular supply
SCIWORA
Spinal Cord Concussion/Central Cord
Laceration/Transection
Missile injury / Bony Fragment injury
Dumont & Hurlbert et al. Clinical Neuropharmacology 24(5):254-264 2001.
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Mechanisms of Primary SCI
Impact w/ persistent compression
Burst # w/ canal compromise#/Dislocationacute disc rupturesmost common SCI (young, high nrg)
Impact w/ transient compression
hyperextension w/ underlying spondylosiscentral cord syndrome2nd most common (older, low nrg)
Distraction
stretch/shear injury of cord and vascular supply
SCIWORA
Spinal Cord Concussion/Central Cord
Laceration/Transection
Missile injury / Bony Fragment injury
Dumont & Hurlbert et al. Clinical Neuropharmacology 24(5):254-264 2001.
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Mechanisms of Primary SCI
Impact w/ persistent compression
Burst # w/ canal compromise#/Dislocationacute disc rupturesmost common SCI (young, high nrg)
Impact w/ transient compression
hyperextension w/ underlying spondylosiscentral cord syndrome2nd most common (older, low nrg)
Distraction
stretch/shear injury of cord and vascular supply
SCIWORA
Spinal Cord Concussion/Central Cord
Laceration/Transection
Missile injury / Bony Fragment injury
Dumont & Hurlbert et al. Clinical Neuropharmacology 24(5):254-264 2001.
![Page 12: Spinal Cord Injury - cumming.ucalgary.ca · Spinal Cord Injury Epidemiology and Pathophysiology Forrest Hsu and Dr. Hurlbert University of Calgary Neurosurgery Halfday February 05,](https://reader033.vdocument.in/reader033/viewer/2022053006/5f09fb837e708231d429715b/html5/thumbnails/12.jpg)
Mechanisms of Primary SCI
Impact w/ persistent compression
Burst # w/ canal compromise#/Dislocationacute disc rupturesmost common SCI (young, high nrg)
Impact w/ transient compression
hyperextension w/ underlying spondylosiscentral cord syndrome2nd most common (older, low nrg)
Distraction
stretch/shear injury of cord and vascular supply
SCIWORA
Spinal Cord Concussion/Central Cord
Laceration/Transection
Missile injury / Bony Fragment injury
Dumont & Hurlbert et al. Clinical Neuropharmacology 24(5):254-264 2001.
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Mechanical SCI primarily injures grey matter
Relative sparing of white vs grey matter tracts in mechanical injury
grey matter softer, more vascular, more metabolically active
Extrapolation from CBF Grey matter =75-80 vs White matter 20-30 cc/100gm tissue/min
Tator CH Brain Pathology 5:407-413, 1995.Hickey et al. Stroke 17:1183, 1986
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Spinal cord autoregulation is impaired in acute SCI
adapted from Guha et al. Stroke 20:372, 1989
adjacent to injury site
injury site
Hickey et al. Stroke 17:1183, 1986
Impaired Spinal Cord Autoregulation
Spinal cord perfusion linearly dependent on MAP at both site and adjacent to site of injury
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Sympathetic Disruption in Acute SCIFurlong and Fehlings. Neurosurgery Focus. 2008.
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Shock in Acute SCI
Distributive-Neurogenic Shock
sympathetic disruption resulting in bradycardia and vasodilationloss of muscle tone causing venous pooling
Hypovolemic
Massive blood lossMulti-trauma; Chest, Abdo-pelvic,long bony
Obstructive
flow of blood obstructed through cardio-pulmonary circuit
cardiac tamponade/tension pneumothorax
Cardiogenic
acute MI/arrhythmia 2º truama/stress/co-morbiditiesbrainstem irritation/injury
Furlong and Fehlings. Neurosurgery Focus 25(5):E13 2008.
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Mechanism of Vascular Injury in Acute SCI
Mechanical disruption
Systemic shock from Hemorrhage, Obstruction, Neurogenic
Impairment of Spinal Cord perfusion and autoregulation
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Kwon and Vaccarro et al. The Spine Journal 4:451-464 2004.
Progressive Necrosis and Apoptosis Central in Secondary SCI
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Dumont & Hurlbert et al. Clinical Neuropharmacology 24(5):254-264 2001.
Mechanisms of Secondary SCI
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Ronsyn et al. Spinal Cord 46:532-539 2008.
Targeting treatments for secondary SCI