Systemic hypothermia in acute cervical spinal cord injury a case-controlled study

Summary Spinal cord injury SCI is a devastating condition that affects approximately 11, patients each year in the United States. Accordingly, it is necessary to develop novel therapeutic interventions to delay the progression of the pathophysiological processes associated with secondary injury to limit the degree of SCI-induced neurological dysfunction, such as hypothermia.

Inanother young athlete, a year-old gymnast named Jorge Valdes, walked out of the hospital 7 days after receiving systemic cooling and surgery for a cervical spine injury.

Cervical SCI often results in tetraplegia, difficulty breathing, and dysregulation of autonomic functions including heart rate, blood pressure and body temperature.

In other studies, hypothermia protection has also been shown in models of compression injury that lead to reduced blood flow to the focal area of the injured spinal cord [ 263235 — 3764 ].

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Among people older than 65, SCI is mostly induced by falls [ 1 ]. A significant improvement in mean motor scores was found in the riluzole group compared with the control group mean difference, Indeed, therapeutic hypothermia has recently been adopted by the American Heart Association as a treatment for cardiac arrest, and to date it is the only cytoprotective treatment that has been successfully translated from the bench to the bedside.

In contrast to systemic hypothermia, local cooling allows very low levels of hypothermia to be introduced without potentially initiating inherent physiological effects, such as hypotension, bradycardia, and respiratory infection that can be seen in conditions in which systemic hypothermia is used [ 48526768 ].

Methods In this study, we systematically review and meta-analyse the literature to determine the efficacy of systemic and regional hypothermia in traumatic SCI, the experimental conditions influencing this efficacy, and the influence of study quality on outcome.

Most victims are young men, and the majority of these individuals are left with severe paralysis and functional deficits that remain for the rest of their lives.

TH remains an experimental clinical approach and randomized multicenter trials are needed to critically evaluate this potentially exciting therapeutic intervention targeting this patient population.

The Changing Face of Spinal Cord Injury Trials

In these studies, different levels or durations in cooling have also been shown in most cases to promote recovery. Functional recovery following traumatic spinal cord injury mediated by a unique polymer scaffold seeded with neural stem cells.

Much of the pre-clinical investigative data on the use of hypothermia post-injury, which was pioneered by Miami Project and Miller School researchers, led senior author Allan Levi, M.

Each individual experiment of control cohort versus treatment cohort is herein defined as a comparison. Thoracic and lumbosacral SCI often produces locomotor dysfunction in the legs and hips, the loss of control of the bowel and bladder, as well as sexual dysfunction.

Inhe began to perform studies on lower temperature and the effects on cellular growth. This article has been cited by other articles in PMC. Recent studies using clinically relevant animal models of SCI have reported the efficacy of therapeutic hypothermia TH in terms of promoting long-term behavioral improvement and reducing histopathological damage.

Although case reports and small series from some time ago also suggest a potential clinical benefit, a substantial clinical trial utilising regional hypothermia has not been conducted [5][6].

We explored the impact of the reporting of measures to minimise bias on the complete dataset.

The “Cold Cord”: A Review of Therapeutic Hypothermia for Traumatic Spinal Cord Injuries

Written by Kristin Della Volpe and Susan Spinasanta New research on interventions for spinal cord injury is emerging at a rapid pace. In a recent study by Batchelor et al. Electronic supplementary material The online version of this article doi: Where functional outcome was measured serially we extracted data for the last time point reported.

Clinical application of modest hypothermia after spinal cord injury.

Systemic hypothermia in acute cervical spinal cord injury: A case-controlled study

Analysis of these two datasets were performed according to: The overall behavioural improvement with regional hypothermia was In other domains, systematic review and meta-analysis have been used to identify the experimental conditions providing maximum efficacy and identify where bias has led to overestimations of treatment effects [7][8].

Nevertheless, a weakness of local cooling is that the procedure cannot be initiated until rather invasive surgical approaches are completed to allow for the application of cold fluid onto the surface of the injured spinal cord. Biomaterials Use of bioengineered scaffolds that are conducive to cellular attachment and neurite outgrowth have shown promising results in rodent and primate models.

These approaches were very cumbersome, and it was different to maintain critical levels of hypothermia for long periods of time. Hypothermia has also been combined with other interventions, such as antioxidants, anesthetics, alkalinization and cell transplantation for additional benefit.

In clinically relevant SCI studies, mild reductions in temperature have been shown to be protective, whereas mild elevations hyperthermia have been reported to worsen outcome [ 38 — 40 ]. Introduction Therapeutic hypothermia has emerged as a clinically useful neuroprotective treatment, substantially improving neurological outcomes following both cardiac arrest and neonatal hypoxic ischaemic encephalopathy.

Conceived and designed the experiments: Levi and his Miami Project colleagues published initial papers showing the effectiveness of mild hypothermia for spinal cord injuries in the March issue of the Journal of Neurotrauma and the April issue of Neurosurgery.

A prospective, multicenter, phase I matched-comparison group trial of safety, pharmacokinetics, and preliminary efficacy of riluzole in patients with traumatic spinal cord injury. Our inclusion criteria consisted of the i reporting of efficacy of hypothermia on functional outcome ii number of animals and iii mean outcome and variance in each group.

The most common causes of SCI are motor vehicle accidents, falls and sports injuries. Cell-based therapies are believed to work through one of three principle mechanisms: Fehlings and colleagues found an improved trajectory of outcome in patients with cervical spinal cord injury who took mg riluzole twice daily within 12 hours of injury for 14 days.

Spinal cord injuries in the United States affect roughly to people, with approximately 12 additional cases each year. Systemic hypothermia in acute cervical spinal cord injury: a case-controlled study Systemic hypothermia in acute cervical spinal cord injury: a case-controlled study.

Jan 11, For further details, click here. By The Par-QoL team | T+ January 11th, | News & events, Uncategorised | 0 Comments. Systemic hypothermia in acute cervical spinal cord injury: a case-controlled study Published: December 18, | Source: Systemic hypothermia remains a promising neuroprotective strategy.

Systemic Hypothermia in Acute Cervical Spinal Cord Injury The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government.

Background. Therapeutic hypothermia is a clinically useful neuroprotective therapy for cardiac arrest and neonatal hypoxic ischemic encephalopathy and may potentially be useful for the treatment of other neurological conditions including traumatic spinal cord injury (SCI).

Systemic hypothermia in acute cervical spinal cord injury: a case-controlled study. Spinal Cord.

Systemic hypothermia in acute cervical spinal cord injury: a case-controlled study

;51(5) 9. Levi AD, Casella G, Green BA, et al. Clinical outcomes using modest intravascular hypothermia after acute cervical spinal cord injury. Neurosurgery. ;66(4) Levi AD, Green BA, Wang MY, et al. Clinical. The use of systemic hypothermia for the treatment of an acute cervical spinal cord injury in a professional football player.

Spine. ; E57–E doi: /BRS.0beb9dc

Systemic hypothermia in acute cervical spinal cord injury a case-controlled study
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