Prehospital Protocols Reducing Long Spinal Board Use Are Not Associated with a Change in Incidence of Spinal Cord Injury
Gaither, Joshua B
Rice, Amber D
N Blust, Robyn
Bobrow, Bentley J
AffiliationUniv Arizona, Coll Med, Dept Emergency Med, Arizona Emergency Med Res Ctr
Keywordsemergency medical services
long spinal board
spinal cord injury
spinal motion restriction
MetadataShow full item record
PublisherTAYLOR & FRANCIS INC
CitationFranco Castro-Marin, Joshua B. Gaither, Amber D. Rice, Robyn N. Blust, Vatsal Chikani, Anne Vossbrink & Bentley J. Bobrow (2019) Prehospital Protocols Reducing Long Spinal Board Use Are Not Associated with a Change in Incidence of Spinal Cord Injury, Prehospital Emergency Care, DOI: 10.1080/10903127.2019.1645923
JournalPREHOSPITAL EMERGENCY CARE
RightsRights managed by Taylor & Francis.
Collection InformationThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at firstname.lastname@example.org.
AbstractIntroduction: Many emergency medical services (EMS) agencies have de-emphasized or eliminated the use of long spinal boards (LSB) for patients with possible spinal injury. We sought to determine if implementation of spinal motion restriction (SMR) protocols, which reduce LSB use, was associated with an increase in spinal cord injury (SCI). Methods: This retrospective observational study includes EMS encounters from January 1, 2013 to December 31, 2015 submitted by SMR-adopting ground-based agencies to a state EMS database with hospital discharge data. Encounters were excluded if SMR implementation date was unknown, occurred during a 3-month run-in period, or were duplicates. Study samples include patients with traumatic injury (TI), possible spinal trauma (P-ST), and verified spinal trauma (V-ST) using hospital discharge ICD-9/10 diagnosis codes. The incidence of SCI before and after implementation of SMR was compared using Chi-squared and logistic regression. Results: From 1,005,978 linked encounters, 104,315 unique encounters with traumatic injury and known SMR implementation date were identified with 51,199 cases of P-ST and 5,178 V-ST cases. The incidence of SCI in the pre-SMR and post-SMR interval for each group was: TI, 0.20% vs. 0.22% (p = 0.390); P-ST, 0.40% vs. 0.45% (p = 0.436); and V-ST, 4.04% vs. 4.37% (p = 0.561). Age and injury severity adjusted odds ratio of SCI in the highest risk cohort of patients with V-ST was 1.097 after SMR implementation (95% CI 0.818-1.472). Conclusion: In this limited study, no change in the incidence of SCI was identified following implementation of SMR protocols. Prospective evaluation of this question is necessary to evaluate the safety of SMR protocols.
Note12 month embargo; published online: 14 August 2019
VersionFinal accepted manuscript
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Neurophysiological Changes After Paired Brain and Spinal Cord Stimulation Coupled With Locomotor Training in Human Spinal Cord InjuryPulverenti, T.S.; Zaaya, M.; Grabowski, M.; Grabowski, E.; Islam, M.A.; Li, J.; Murray, L.M.; Knikou, M.; Bio-Science Research Laboratory, The University of Arizona (Frontiers Media S.A., 2021)Neurophysiological changes that involve activity-dependent neuroplasticity mechanisms via repeated stimulation and locomotor training are not commonly employed in research even though combination of interventions is a common clinical practice. In this randomized clinical trial, we established neurophysiological changes when transcranial magnetic stimulation (TMS) of the motor cortex was paired with transcutaneous thoracolumbar spinal (transspinal) stimulation in human spinal cord injury (SCI) delivered during locomotor training. We hypothesized that TMS delivered before transspinal (TMS-transspinal) stimulation promotes functional reorganization of spinal networks during stepping. In this protocol, TMS-induced corticospinal volleys arrive at the spinal cord at a sufficient time to interact with transspinal stimulation induced depolarization of alpha motoneurons over multiple spinal segments. We further hypothesized that TMS delivered after transspinal (transspinal-TMS) stimulation induces less pronounced effects. In this protocol, transspinal stimulation is delivered at time that allows transspinal stimulation induced action potentials to arrive at the motor cortex and affect descending motor volleys at the site of their origin. Fourteen individuals with motor incomplete and complete SCI participated in at least 25 sessions. Both stimulation protocols were delivered during the stance phase of the less impaired leg. Each training session consisted of 240 paired stimuli delivered over 10-min blocks. In transspinal-TMS, the left soleus H-reflex increased during the stance-phase and the right soleus H-reflex decreased at mid-swing. In TMS-transspinal no significant changes were found. When soleus H-reflexes were grouped based on the TMS-targeted limb, transspinal-TMS and locomotor training promoted H-reflex depression at swing phase, while TMS-transspinal and locomotor training resulted in facilitation of the soleus H-reflex at stance phase of the step cycle. Furthermore, both transspinal-TMS and TMS-transspinal paired-associative stimulation (PAS) and locomotor training promoted a more physiological modulation of motor activity and thus depolarization of motoneurons during assisted stepping. Our findings support that targeted non-invasive stimulation of corticospinal and spinal neuronal pathways coupled with locomotor training produce neurophysiological changes beneficial to stepping in humans with varying deficits of sensorimotor function after SCI. © Copyright © 2021 Pulverenti, Zaaya, Grabowski, Grabowski, Islam, Li, Murray and Knikou.
The transformation of spinal curvature into spinal deformity: pathological processes and implications for treatmentHawes, Martha; O'Brien, Joseph; Division of Plant Pathology and Microbiology, Department of Plant Sciences, University of Arizona, Tucson AZ 85721, USA; National Scoliosis Foundation, 5 Cabot Place, Stoughton MA 02072, USA (BioMed Central, 2006)BACKGROUND:This review summarizes what is known about the pathological processes (e.g. structural and functional changes), by which spinal curvatures develop and evolve into spinal deformities.METHODS:Comprehensive review of articles (English language only) published on 'scoliosis,' whose content yielded data on the pathological changes associated with spinal curvatures. Medline, Science Citation Index and other searches yielded > 10,000 titles each of which was surveyed for content related to 'pathology' and related terms such as 'etiology,' 'inheritance,' 'pathomechanism,' 'signs and symptoms.' Additional resources included all books published on 'scoliosis' and available through the Arizona Health Sciences Library, Interlibrary Loan, or through direct contact with the authors or publishers.RESULTS:A lateral curvature of the spine-'scoliosis'-can develop in association with postural imbalance due to genetic defects and injury as well as pain and scarring from trauma or surgery. Irrespective of the factor that triggers its appearance, a sustained postural imbalance can result, over time, in establishment of a state of continuous asymmetric loading relative to the spinal axis. Recent studies support the longstanding hypothesis that spinal deformity results directly from such postural imbalance, irrespective of the primary trigger, because the dynamics of growth within vertebrae are altered by continuous asymmetric mechanical loading. These data suggest that, as long as growth potential remains, evolution of a spinal curvature into a spinal deformity can be prevented by reversing the state of continuous asymmetric loading.CONCLUSION:Spinal curvatures can routinely be diagnosed in early stages, before pathological deformity of the vertebral elements is induced in response to asymmetric loading. Current clinical approaches involve 'watching and waiting' while mild reversible spinal curvatures develop into spinal deformities with potential to cause symptoms throughout life. Research to define patient-specific mechanics of spinal loading may allow quantification of a critical threshold at which curvature establishment and progression become inevitable, and thereby yield strategies to prevent development of spinal deformity.Even within the normal spine there is considerable flexibility with the possibility of producing many types of curves that can be altered during the course of normal movements. To create these curves during normal movement simply requires an imbalance of forces along the spine and, extending this concept a little further, a scoliotic curve is produced simply by a small but sustained imbalance of forces along the spine. In fact I would argue that no matter what you believe to be the cause of AIS, ultimately the problem can be reduced to the production of an imbalance of forces along the spine 1].
Neuromodulation of the intrinsic stimulus current-spike frequency relationship of spinal motoneurons in the adult turtleStuart, Douglas G.; Hornby, Thomas George (The University of Arizona., 2000)Shortly following the advent of intracellular (IC) recording from spinal cord (SC) motoneurons (MNs) in the anesthetized cat, Eccles (1957) proposed that MNs behave passively in response to synaptic input. It is now known, however, that repetitive MN discharge is subject to the influence of endogenous neurotransmitters and neuromodulators that alter sub- and/or supra-threshold ionic conductances. Much of the literature in this field is anecdotal and focussed on ionic mechanisms. Further research is therefore required on the robustness of neuromodulatory effects, their significance during natural and fictive movements, and their generalization across vertebrate species. Accordingly, the purpose of this study was to quantitate the effects of neuromodulation on MN properties determined from the SC slice of the adult turtle. The present work is divided into four parts. The first (Chapter 2) summarizes the literature on MN behavior as determined from a variety of vertebrate preparations. The second (Chapter 3) provides an evaluation of the robustness of the electrophysiological measurements made from turtle SC MNs and compares them to analogous results from the lamprey and cat. The third part (Chapter 4) reports on the MNs' responses to three excitatory and one inhibitory neuromodulator. The MN population was divided into two groups on the basis of their propensity to generate plateau potentials (PPs). In PP MNs, the slope of the stimulus current-spike frequency relation was flattened to an extent comparable to recent findings in the decerebrate cat preparation. The fourth component of the study (Chapter 5) provides a comparison of MN behavior in a variety of preparations across vertebrate species, with particular emphasis on the functional efficacy of the PP. In summary, the present work has provided a new opening in the study of neuromodulation on vertebrate spinal MN properties by quantifying the effects of such modulation. In addition, the work has added further evidence supporting an evolutionary conservation of MN properties across vertebrates, with a particular emphasis on the functional significance of the PP as a key determinant of MN discharge.