Posts from ‘Spinal Cord Injury(SCI)’
Spinal Cord Injury and Afghanistan
Military medical officials have expressed concern over an increase in spinal injuries among U.S. troops coming home from Afghanistan. Afghan insurgents have responded to the increased presence of heavily armored U.S. vehicles with larger and more powerful roadside explosives.
Roadside bombs have become the top killer of U.S. troops in Iraq and Afghanistan. Not only do the roadside bombs lead to crushed spines and other spinal injuries, they also result in traumatic brain injuries when soldiers are exposed to blasts, even with no impact to the head.
A USA Today story reported that the recent increase in spinal injuries occurred among soldiers in Afghanistan and not Iraq. The increase in spinal cord injuries among troops has arisen due to increased potency in roadside bombs used by insurgents. The U.S. Military issued 3500 Mine Resistant Ambush Protected (MRAP) vehicles as an attempt to deal with the roadside bombings. Unfortunately, Afghanistan insurgents responded with stronger and larger bombs.
Some of the 3500 MRAP vehicles deployed in Afghanistan have been lifted a few feet off the ground by roadside bomb explosions. Even though the MRAP vehicle may remain intact, some soldiers have suffered serious spinal cord injuries in the explosions. The MRAP vehicles cost about $1.4 million.
Medical professionals and Army engineers are comparing data to explore possible alterations and improvements to the MRAP vehicle design to make it safer for soldiers who are exposed to increasing roadside bomb possibilities. The MRAP vehicles, which cost about $1.4 million to make, have a hull designed in a V-shape, which helps to deflect the force of explosions away from the center of the vehicle, the USA Today article reported.
Since there are very few paved roads in Afghanistan, rebels can easily bury roadside explosives in the dirt roads, undetectable to soldiers driving along the roads at high speeds. Although the military has recently send over newer and lighter MRAP vehicles with better seating and harnesses, more improvements are still in the works to ensure the vehicles are safe for combat.
Doctors are matching up data on injuries with the victims’ positions in the vehicles at the time of the explosion and the vehicle type in which the accident occurred. Their hope is that engineers will be able to use the data to design more explosion-proof MRAP vehicles and to prevent any further incidence of spinal cord injuries if possible. USA Today reported that a doctor in Kandahar is currently at work designing a shock-absorbing seat that would provide a better guard against spinal cord injuries.
References:
- Zoroya, Gregg. (November 5, 2009). “Spinal Injuries Up Among Troops.” Retrieved December 6, 2009 from the USA Today website: http://www.usatoday.com/NEWS/usaedition/2009-11-04-1Aied04_ST_U.htm?csp=34
Spinal cord injury patients around the world may draw new hope for the future from the story of a paralyzed little dog who was able to walk again after receiving an experimental spinal cord treatment. Cambridge University scientists pioneered the new treatment that made it possible for Henry the dachshund to walk after he was paralyzed by a severe spinal cord injury.
Veterinarians at the Cambridge Veterinary School took cells from the dog’s nose and injected them into his ailing spinal cord. The New York Daily News reported that nose cells were used because they encourage the growth of new nerve fibers in the spinal cord. Henry had lost the ability to walk at the end of last year when discs between the vertebrae in his spine ruptured. It was also reported that certain species of canines have an increased risk of spinal cord injuries, so they make good candidates for exploration of experimental treatments.
Scientists had previously reported success with the nose cell technique in experiments with rats, which inspire professors Nick Jeffrey and Robin Franklin to attempt the experimental procedure on the dachshund. The scientists hope to eventually use the procedure to treat human patients with severe spinal cord injuries.
In addition to the medical treatment, Henry received physiotherapy and rehabilitation on a treadmill. Only a month after getting the nose cell treatment, Henry was able to walk again. The poor little puppy was reportedly downtrodden and depressed before he received the procedure. Afterward, his owner reported signs of the dog’s returning happiness.
Sarah Beech, the owner of the lucky dachshund, was amazed by the miraculous results of the veterinary treatment. She was quoted in the New York Daily News article saying, “It’s incredible,” Henry’s owner, Sarah Beech, told the Daily Mail. “I didn’t think Henry would ever be able to walk again, but over the last few months, he has been wagging his tail and taking small steps.”
The news of such rapid success in reversing Henry’s paralysis should bring hopeful expectation to the many spinal cord injury patients waiting for such amazing treatments to be made available to humans. With all the recent advances in spinal cord injury treatments, it seems only a matter of time before paralysis is seen as a temporary, instead of irreversible, condition.
(pic from flickr.com/photos/franklin_hunting)
Upwards of 250,000 people suffer from severe spinal cord injuries, and many of those patients have lost the ability to use their arms, legs, or even most of their bodies. There are very few treatment options available for paralysis and spinal cord injury victims, but a recent article in Health Scout from the Ivanhoe Broadcast News reported on a controversial camp that is providing new hope for many patients. The camp in question is in Sanford, Florida, and patients at the camp are encouraged to get out of their wheelchairs and “stand on their own,” the article reported.
One patient, 20-year-old quadriplegic Amanda Perla, was mentioned in the article as being able to stand by herself with the help of a metal bar. Two years ago, Amanda was paralyzed in a tragic car accident on her prom night. She was told by doctors she would never walk again and would be bound to a powered wheelchair for the rest of her life, but six months later, with the help of the Step Up Recovery Center, she has transitioned to a manually powered wheelchair.
The owner and founder of the Step Up Recovery Center, Amanda Perla’s mother Liza Reidel, opened up the center as her response to the hopelessness and lack of available treatment options presented to her daughter by doctors. At the center, spinal cord injury recovery specialists prompt patients to get up out of their wheelchairs and perform “aggressive exercise and repetitive motions” in an attempt to “reorganize the nervous system,” the article read.
While some doctors have criticized the recovery center for providing false hope to its patients, the goals of the center are to “help patients regain function,” and to “possibly even walk again.” Although Amanda Perla is still bound to a wheelchair, she noted that she has already recovered beyond the expectations of her doctors, and she believes that with further treatment and rehabilitation she will walk again some day.
Clients at the recovery center undergo three-hour therapy sessions three or four times a week. While critics worry about giving patients false hope, the center advocates progressive action in the face of an otherwise dreary prognosis. It is a progressive advance to offer movement therapy and physical rehabilitation attempts to patients who would otherwise have resigned themselves to life in wheelchairs with no hope.
Although patients at the center have yet to walk again after paralysis, the increased movement and deliberate exercise is something the patients would not otherwise be exposed to, and in that sense, it provides a positive option where one did not previously exist.
(pic from flickr.com/photos/meanestindian)
With healthcare reform dominating the news lately, many brain and spinal cord injury patients have to be pondering the question- what does this all mean for those of us with existing injuries? Will we get improved coverage? Or will we be left in the dust, worse off than we were before? Will Obama deliver on his promise to provide affordable health care for all Americans? The recent bill passed by the Senate Finance Committee may provide some answers. The bill, if passed into law by the Senate and the House of Representatives, would restrict insurance companies from being able to reject or charge higher premiums to those with pre-existing conditions.
While the Senate Finance Committee healthcare reform plan was fully expected to pass in last Tuesday’s vote, which it did, a new insurance-industry-funded report leaked over the weekend tried to convince voters that the Senate legislation would substantially increase premiums for individuals. A White House Spokesman told the Washington Times that the report, commissioned by America’s Health Insurance Plans (AHIP), was a “self-serving analysis from the insurance industry.”
The bill, if passed, would require all Americans to obtain health insurance, and would issue penalties to those who did not obtain it. Maine’s senator, Olympia J. Snowe, is the only republican senator on the committee who voted in favor of the health care reform bill. Snowe also helped by adding an amendment to the bill to reduce the penalties recommended for those who did not obtain health insurance in time, according to a Washington Times article. The amendment to reduce penalties was passed unanimously by the committee.
Since the bill was not stalled by the Senate Finance Committee, it now remains in the hands of the Senate to determine whether or not it will move closer to becoming law in a vote expected to occur later this month.
Republicans used the AHIP report to bolster their case against what some have termed, “Obamacare.” Senate minority leader Mitch McConnell, R-Ky, told USA Today that the health care plan in question will lead to, “higher premiums, higher taxes, and more government.” Senator Jay Rockefeller, D-W.Va said to USA Today that, “The [insurance] industry stands today as the greatest impediment to health care reform.”
The AHIP, who commissioned the controversial report, responded by saying, “We don’t see comprehensive cost control in any piece of legislation.”
While the Senate Finance Committee passed the healthcare reform bill on Tuesday, there still remains much work and compromise between democrats and republicans before a bill will be voted on and agreed upon between both the Senate and House of Representatives. They will all have to come to an agreement or a compromise before any serious overhaul of the health care system will be possible.
If passed into law, the bill passed to the Senate by the Senate Finance Committee would extend health insurance coverage to the over 30 million Americans currently without health insurance. The over 20 million illegal immigrants currently working in the United States would still remain without health insurance, as article in the Guardian reported.
The Senate Finance bill will cost $829 billion over ten years if passed into law, and will require all individuals to purchase health care if it costs 8% or less of their total income, and it will offer tax credits to individuals and families under 400% of the poverty line. The bill will also disallow insurance companies from denying coverage to or charging higher premiums for pre-existing conditions or gender.
The details of other proposed healthcare legislation currently being considered in various parts of congress, including President Obama’s personal recommendations, can be found in this article published in the New York Times.
(pic from metric.files.wordpress.com)
The Accreditation Association for Ambulatory Health Care (AAAHC) recently recognized and accredited Laser Spine Institute (LSI) Tampa as a facility that provides the “highest quality of care for patients and a safe work environment for medical staff and employees,” said a recent PRNewswire release. LSI are industry leaders in providing elite care, and resort-like rehabilitation amenities to patients who can benefit from minimally invasive spinal surgeries.
With surgical facilities in Tampa, Florida and Scottsdale, Arizona, as well as consultation facilities in San Diego, California and The Villages, Florida, LSI performs endoscopic outpatient procedures to correct painful spinal issues stemming from bulging and herniated discs, pinched nerves, spinal stenosis, degenerative disc disease, foraminal stenosis, bone spurs, spinal arthritis, and failed open back or neck surgeries.
The AAAHC conducted their usual two-day rigorous on-site survey and both the Tampa and Scottsdale facilities and required LSI to undergo a self-assessment of all of their procedures, policies, and processes. The AAAHC found that LSI met or exceeded all the qualifications necessary for them to receive the highly coveted accreditation.
The LSI facility in Scottsdale has four cutting edge operating rooms, and the Tampa flagship facility has seven. Both locations also provide patient access to MRI, radiology, physical therapy, and examination rooms with state of the art technology and equipment.
All of the surgeries performed at LSI facilities require an incision less than one inch long. Patients undergo examination, surgery, and recovery all at the same location. The PRNewswire release said, “From pre-operative imaging and diagnostic testing, to endoscopic laser surgery and post-operative physical therapy, patients receive the highest quality care combined with the most advanced treatments.”
Cheryl Harper, a former patient of LSI and mother of two young boys had only glowing praise for the treatment she received at the LSI facility. She was quoted in the article as saying, “The pain took over my life from morning to night. I have two little boys and I was always tired. After surgery, I feel like I’ve added 10 to 20 years onto my life. Now I’m active and spending time with my family, especially my two little boys.”
Potential patients of LSI who suffer from back or neck pain can get more information by visiting LSI’s website at http://www.laserspineinstitute.com or by calling 1-877-205-7498.
(pic from flickr.com/photos/andreanna)
Manufacturers of dynamic spine stabilization systems may be sent back to the proverbial drawing board to improve their devices after a recent Food and Drug Administration (FDA) injunction ordered them to conduct new studies to insure the safety of their products. The FDA ordered the manufacturers to conduct post-market surveillance studies to monitor fusion rates and other possible safety issues related to the stabilization products. The FDA order also requires manufacturers to gather pre-market clinical data on not-yet-released products. The order may result in labeling changes on future devices.
The FDA’s concern arose due to a lack of substantial clinical data to show how well the devices in question provide support for complete spinal fusions. Their concern is that there is not enough data to conclusively demonstrate that the devices are strong enough. The FDA worries that the dynamic stabilization systems may loosen, break, or bend under pressure over time. If the devices do happen to be faulty, spinal injury patients would be at great risk of suffering additional injuries and may require further surgical procedures. The FDA order does not affect the methods by which the stabilization devices are employed.
Older conventional spinal stabilization systems consist of screws and metal rods anchored into the spine during bone fusion spinal surgeries. Dynamic systems are different. They employ flexible polymer cords, springs, and movable screw heads to allow patients the freedom to bend and rotate their spine, which the conventional systems do not.
The FDA order insists that post-market studies investigate: the rate of fusion in the dynamic systems compared to traditional rigid systems; details, rates, and severity of any side effects, also compared to rigid systems; additional surgeries and types of surgeries required for dynamic systems vs. the rigid models; and finally, any and all causes of failure of any systems leading to a surgical removal of the devices from patients’ spines.
Since bone fusion devices are classified as class II devices in FDA labeling regulations, newer-model devices are allowed to be developed and manufactured if they are demonstrated to be substantially equivalent to predecessor devices already approved on the market.
Dynamic stabilization systems first received approval from the FDA in 1997, and they will likely continue to be used in the future. The FDA mandate promises to improve the effectiveness and safety of such devices.
(pic from drsharma.ca)
A double-blind study release on August 5, 2009 in the New England Journal of Medicine showed that vertebroplasty a procedure that involves the injection of medical cement into the spines of patients who have spinal fractures proved only equally effective as simulated vertebroplasty with no spinal cement injection. One group of patients received the actual vertebroplasty procedure, and the control group received a mock procedure including everything but the cement injections into their spines.
The study’s leader, Dr. David Kallmes, said that while vertebroplasty has been long accepted and utilized as a treatment option for many years, there has been no data or research to verify its effectiveness. The findings of the study conducted by a team of researchers at the Mayo Clinic in Rochester, MN showed that relief of pain and improvement in dysfunctions related to the pain proceeded similarly in both the group of patients who received the vertebroplasty and the control group who did not. The progress of the patients involved in the study will continue to be monitored over the course of one year, after which the comprehensive results of the study will be published.
The study was partially motivated by doctors’ concerns that the cement injections into patients’ spines could potentially increase the risk of future spinal cord injuries. Dr. Kallmes was careful to add that vertebroplasty does actually work. However, scientists and doctors may be able to achieve similar results without the potentially dangerous cement injections.
Kallmes was quoted in a EurekAlert article speculating that the improvements recorded in the control group could be the result of, “…local anesthesia, sedation, patient expectations, or other factors.” He also advised patients to seek professional advice before deciding on treatment options. Many other studies related to treatment for spinal fractures are currently underway at the Mayo Clinic. They will be reported on as the studies and their findings are published.
Many other institutions were involved in the vertebroplasty study, including: the University of Washington, Seattle; Nuffield Orthopaedic Centre NHS Trust, Oxford, UK; St. George Hospital, University of New South Wales, Sydney, Australia; Gartnavel General Hospital, Glasgow, UK; Department of Social Medicine, Bristol, UK; Nottingham University Hospital NHS Trust, UK; and Western General Hospital, University of Edinburgh, UK.
The huge amount of global attention dedicated to improving conditions for spinal cord injury patients is encouraging. Their dedication is producing constant improvements in the quality of care and effectiveness of treatments around the world.
(pic from spineuniverse)
Janneke J. P. Schimmel, MSc, a scientist at Sint Maartenskliniek in Nijmegen, The Netherlands, recently spoke about the findings of a study on the occurrence of infections in lumbar fusion surgery sites. The study performed by Schimmel and a team of Dutch researchers showed that there is a link between lumbar spinal fusion surgery and surgical site infections on surgeries done in the same location.
Orthopedics Today quoted Schimmel who said, “Our main finding is that previous surgery was associated with the higher risk for the appearance of an infection. More complex surgery resulted in an increase for the infection rates.” She also noted that the longer it took to perform a spinal surgery, the higher the chance of infection at the surgery site. Schimmel reported on the findings of the 9-year-long study in Miami, Florida at the 36th Annual Meeting of the International Society for the Study of the Lumbar Spine.
The investigators gathered and analyzed data on more than 1400 patients who had received lumbar fusion surgery in The Netherlands between 1999 and 2007. The study identified many factors concurrent with the appearance of deep infections at the site of the operations. In addition to factors already mentioned, patients who smoke cigarettes, and patients with diabetes mellitus were also found to be at greater risk of deep infections after lumbar spinal fusion surgery. The data for the study was collected from hospital databases and patient charts.
The intensive study showed that out of 1454 patients, 31 of them tested positive for bacterial infections. Nearly all of the infections found were caused by Staphylococcus basteria.
The increased costs of treatment for postoperative infections are staggering. Over 1000 extra hospital days were required for further treatment of patients with deep infections in their spines. The Orthopedics Today article reported that it is extremely costly to treat and care for deep infections due to longer hospital stays and expensive pharmaceuticals, lab tests, and other necessary procedures.
Some implications of the study suggest that shortening the length of time it takes to perform lumbar fusion surgery could lessen the chance of infection. This may inspire innovative surgeons and researchers to develop faster, more efficient, and less invasive procedures for lumbar surgery in the future.
(pic from flickr.com/photos/doctorow)
Spinal Cord injury and spinal cord dysfunction patients have new cause to celebrate. Last week marked the official launch of the Academy of Spinal Cord Injury Professionals. With support form the Paralyzed Veterans of America, the new interdisciplinary academy aims at improving the quality of care and quality of life for spinal cord injury patients.
Nurses, doctors, social workers, rehabilitation therapists, and psychologists will be able to work together more closely as part of the new academy to share data and pool their knowledge and experience to work toward developing more effective treatment plans and improving the quality of life-long care for those suffering with spinal cord injuries.
The Academy of Spinal Cord Injury Professionals arose as a merger between the American Association of Spinal Cord Injury Nurses, the American Paraplegia Society, the American Association of Spinal Cord Injury Psychologists and Social Workers, and the Therapy Leadership Council in Spinal Cord Injury.
The professionals who make up the academy hope to achieve their goals by way of: raising public, lawmaker, and charitable organization awareness of the challenges of life with spinal cord injury; encouraging community development in support of spinal cord injury patients; and providing advanced networking opportunities for spinal cord injury professionals.
As in many areas of science, an interdisciplinary collaboration can result in revelations and rapid advances in applicable knowledge due to the sharing of experience and information facilitated by such partnerships. For example, a spinal cord injury psychologist may be able to assist as a liaison between patient and family and between patient and doctor, making communication and understanding more easily achieved for all parties involved.
The Academy of Spinal Cord Injury Professionals uses “Many Minds, One Vision,” as their tagline. The vision statement on their site reads, “The Academy of Spinal Cord Injury Professionals aims to be the world’s premier, interdisciplinary organization dedicated to advancing the care of people with spinal cord injury/dysfunction. We have one vision: it is a world where people with disabilities are healthier, more independent, and more empowered through a comprehensive lifetime of care and full community participation to take on all the challenges that life presents.”
The Ohio State Medical Center (OSMC) recently published a study online in the Journal of Clinical Investigation. The study explored the effects of the body’s immune response after a spinal cord injury. It was already widely known that immune cells gather and release large amounts of antibodies in spinal fluid around a fresh injury site. Up until the OSMC study was published, no one knew exactly how those antibodies affected the injury. The study revealed that antibodies can actually damage and worsen the spinal cord injury by confusing the immune system into attacking the cells near the injury site as a response.
The study leader, Phillip G. Popovich, discerned a possible solution to the problem they identified. By inhibiting certain antibody-producing cells, the scientists asserted, a spinal cord injury patient might benefit from faster healing and reduced risk of more severe long-term damage. Popovich said, “[The antibodies] may also help explain why the central nervous system does not repair itself efficiently and why other impairments often follow spinal cord injury.”
The study was conducted using anaesthetized mice that had been given moderate spinal injuries. Half of the mice had normal immune systems and the other half had immune systems that did not produce antibodies. The group with the inhibited immune systems showed about 30% smaller areas of injury than the mice with normal functioning immune systems.
To determine whether or not it the accumulation of antibodies around the spinal cord injury site was to blame for the larger and more severe injuries, the researchers injected antibodies from injured mice into the spinal cords of healthy mice. They became partially paralyzed and showed signs of damage to their spinal cords only 48 hours after the injections.
Another researcher in the study, Daniel P. Ankeny, said, “These experiments essentially prove that the antibodies have the potential by themselves to make spinal lesions worse.” The researchers also suggested that other health issues that arise in concert with spinal cord injuries might be related to and even caused by the heightened presence of antibodies in the bloodstream. Further research may reveal a host of problems associated with the antibodies in the system.
Better treatments designed to slow down the body’s immune response to spinal cord injuries may result from the findings of this study and further research to determine whether or not the results translate into human patients.
(pic from flickr.com/photos/tudor)
