Acute traumatic spinal cord and cauda equina injury: Nature of the beast, its human and financial costs, and the methods to tame it

Title : Acute traumatic spinal cord and cauda equina injury: Nature of the beast, its human and financial costs, and the methods to tame it

Abstract:

Traumatic spinal cord injuries (TSCI) are potentially lethal and life-changing events from the resulting medical, physical, psychological, social, financial, vocational, environmental & matrimonial effects. The combination of consequent paralysis, generalised physiological impairment, multi-system malfunction, multiple disabilities, wide range of potential complications, sensory impairment together with the non-medical effects impose challenges to patients, carers and clinicians. Early prediction of neurological recovery is important to patients and relatives especially during the early stages following injury. Spontaneous Neurological Recovery is common following traumatic spinal cord damage and is predictable. The neurological recovery can be either local or for long distances below the level of injury. The extent of the recovery depends on the force or impact and the degree of damage to the spinal cord to cause a complete or an incomplete injury. Spontaneous Neurological recovery does not depend on the method of management of the injured spine. Interventions on the injured spine by inexperienced teams of professionals can be more damaging to the spinal cord than useful. The quality of Management of the malfunctioning systems of the body to prevent complications that can further damage the injured spinal cord non-mechanically is at least as important as the prevention of damage from interventions. The positive and negative prognostic indicators of neurological recovery, its extent and the factors that enhance, prevent or cause neurological deterioration in patients with complete and incomplete cord damage will be discussed. I will demonstrate the value of simultaneous Active Physiological Conservative Management (APCM) of the injured spine together with the multi-system physiological impairment and malfunction in achieving optimum neuro-functional recovery as well as the prognostic indicators of the local recovery of patients who remain paralysed and the distal recovery of patients who regain walking. I will also demonstrate that with APCM, local recovery from the segments adjacent to the level of injury who remain paralysed can still have healthy, enjoyable, productive, dignified, contributory and often competitive long lives.

Biography:

Prof W S El Masri FRCS Ed, FRCP currently Hon. Clinical Professor of Spinal Injuries (SI), Keele University has trained between 1971 & 1983 in the Oxford group of hospitals, Guys Hospital in London, Stoke Mandeville hospitals and the USA. He obtained the first accreditation in Spinal Injuries and General Surgery in 1982. Appointed Consultant Surgeon in Spinal Injuries at the Midland Centre for Spinal Injuries in 1983. He personally treated 10,000 patients with SI. He published over 155 manuscripts. He is the author of the: Concepts of “Physiological Instability of the Spinal Cord”, “Time related Biomechanical Instability”, “Micro-instability of the injured spine” and published the largest series to date of Bladder cancer in SCI patients. He has repeatedly demonstrated and published on the discrepancy between the radiological and neurological presentation of patients with acute traumatic SI with and without neurological damage on admission and on discharge. He proposes this is probably due to the loss of some initial force from the impact that damages the bony spine which becomes less injurious to neural tissues. He asserts that further neurological damage can be easily caused by systemic complications that are not too difficult to prevent, as the result of anaesthetic and/or surgical mishaps during intervention and/or poor post-operative care. He advocate for adequate Active Physiological Conservative Management of the injured spine together with the wide range of medical and non-medical effects of the neurological injury from the first few hours or days of injury. He is Past-President of the International Spinal Cord Society; Past Chairman British Association of Spinal Cord Injury Specialists and has lectured world-wide. He won many National and International awards.