unfortunaly everyday we have new spinal cord injury victims.



For Friends and Family of the Newly Injured
Wise Young, Ph.D., M.D.
W. M. Keck Center for Collaborative Neuroscience
Rutgers University, Piscataway, NJ

I receive many calls and emails from people and families with spinal cord injury. It is better today compared to 1977 when I took care of my first spinal-injured patient and had to tell the family that there was nothing that we could do. Here is what I say to families now.

• Focus on solvable problems. Make sure that methylprednisolone is given within 8 hours after injury (this drug may improve recovery by 20%). Find the best and most experienced surgeon. If the spinal cord is compressed, make sure that it is decompressed as soon as possible. Prevent complications by insisting on aggressive care of lung, bladder, and skin. Start rehabilitation as soon as possible.

• Recovery is the rule and not the exception in spinal cord injury. Most people recover some function after spinal cord injury. On average, people with “complete” injuries recover 8% of the function they had lost, compared to 21% if they received methylprednisolone. People with “incomplete” injuries recover 59% of lost function, compared to 75% if they received methylprednisolone. Recovery takes a long time and work. Many people recover function for 2 or more years after spinal cord injury.

• Do not give up hope. Most scientists believe that it is not a matter of if, but a matter of when therapies will be available to restore function in spinal cord injury. Clinical trials are testing therapies to restore function after injury. Weigh potential risks and benefits carefully before participating in such trials. Remember that the therapies will get better over time.

What to ask your doctor?
Families and friends often don’t even know what questions to ask the doctors. Here are some questions to ask in the first hours after injury:

• Was methylprednisolone given? This is the high-dose steroid (30 mg/kg intravenous bolus followed by 5.4 mg/kg/hour for 23 hours if it is started within 3 hours and for 47 hours if between 3 to 8 hours after injury). It should not be started more than 8 hours after injury. Clinical trials have shown that this treatment improves recovery by about 20% when given within 8 hours after injury but does not help when started more than 8 hours after injury. While methylprednisolone is not a cure, every little bit helps. Complications are minimal.

• What is the level and severity of spinal cord injury? The consequences of spinal cord injury depend on the level and severity of injury. Surgeons determine injury levels from the fracture site on the spinal column. This may differ from neurological level determined from sensory and motor loss. Spinal cord injury causes loss of sensation and voluntary movement below the injury site. If the person has motor or sensory function below the injury level at the time of admission, the likelihood of substantial recovery is high.

• Has the spinal cord been decompressed? The spinal cord injury usually results from fracture of vertebral bones that compress the spinal cord. Continued spinal cord compression increases tissue damage and reduces functional recovery. If the neck or cervical segments are fractured, traction may straighten out and decompress the vertebral column. Chest or thoracic fractures cannot be decompressed by traction. Surgery may be necessary to decompress and stabilize the spinal cord.

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