- Village Hotel Changi, Singapore
June 20 to 22, 2025 - +1-571-5561660
neuro@precisionglobalconferences.com
Speakers - INC2025
W S El Masri
- Designation: Clinical Professor of Spinal Injuries, Keele University Emeritus Consultant Surgeon in Spinal Injuries RJ & AH Orthopedic Hospital
- Country: UK
- Title: Determinants of neurological recovery following Traumatic Spinal Cord Injuries
Abstract
Traumatic Spinal Injuries can present with or without neural tissue damage. Both the impact's force and direction determine the presence or absence of neurological damage. The principles of management of the injured spine and the patients with or without neural tissue damage are very different. They are likely to impact the management's neurological and a range of other outcomes. Traumatic spinal cord (tSCI) or cauda equina injuries (tCEI) are life-changing events with medical, physical, psychological, social, financial, vocational, environmental & matrimonial effects. The combination of small incidence (10-50/million population), consequent pan-physiological impairment, multisystem mal fun multisystem impairment/loss, and multiple disabilities, together with their non-medical effects, impose challenges on patients and clinicians alike. This challenge is magnified during the transitional period between the spinal and autonomic areflexia (shock) and the return of these reflexes. During this period, which lasts a few days to weeks, the patient is at a much higher risk of complications than following the return of autonomic and spinal reflex activity.
Fortunately, with simultaneous adequate management of the injured spine, together with each of the effects of cord damage, by a knowledgeable, well-trained, and experienced team of clinicians and health care professionals, almost all complications can be prevented or diagnosed and treated before deterioration, morbidity, and neurological deterioration occur.
Neurological RRecoveryis not uncommon folloRecoveryI & tCEI is predictable and depends on:
- The quality of management of the multisystem Physiol multisystemment and malfunction to prevent systemic and iatrogenic complications that cause further non-mechanical damage to neural tissues by destabilizing the Physiologically Unstable Injured neural tissue
- The adequacy of the management of the Biomechanical Instability of the injured spine to prevent further mechanical damage of the neural tissue from bony or ligamentous structures
- The presence or absence of clinical signs of sensory or sensory-motor sparing at and below the level of injury
Early prediction of ambulation is vital to patients and family members. Neurological RRecoveryis not uncommon. folloRecoveryI & tCEI are predictable and depend on the method and quality of management of the multisystem dysfunction and malfunction as well as that of the spinal injury. In the mid-sixties, Frankel and colleagues made an astute observation that with good conservative management of the injured spine and the multisystem malfuncmultisystements presenting within 15 days of injury with complete motor paralysis but sensory sparing made spontaneous motor recovery from reactivation of the myotomes adjacent to the functioning dermatomes irrespective of the radiological presentation on XXray'son admission and discharge. The same observations, including observations on the discrepancy between the CT and MRI scans and the neurological presentation, have since been repeatedly confirmed by many other international groups. The prognostic indicators of neurological recovery, its extent, the recovery that recovery prevents or causes neurological recovery, and the role of CT and MRI will be discussed.
In the last four decades, routine surgical stabilization and decompression have been carried out on patients with and without traumatic cord damage, supported by claims that surgical intervention is necessary to prevent neurological deterioration and enhance rRecovery The rationale and eviRecoveryr justifying these claims will be discussed and compared with those of the simultaneous Active Physiological Conservative Management of the injury and each Multisystem physiolMultisystemunctions caused by the cord damage.
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