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Thread: Dr.Jhon Hurlbert discusses SCI:College of Medicine, Riyadh, Saudi Arabia

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    Exclamation Dr.Jhon Hurlbert discusses SCI:College of Medicine, Riyadh, Saudi Arabia

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    I am puzzled by what Dr. Hurlbert is saying about acute spinal cord injury in this talk. He is emphasizing a theory that was prevalent about 30 years ago. After claiming that he was going to talk about care of secondary spinal cord injury, he goes on to talk about post-traumatic ischemia and autoregulation. I studied post-injury spinal cord blood flow in the 1980's. The ischemia theory of secondary spinal cord injury is no longer seriously considered by most investigators.

    Traditionally ABC refers to resuscitation: airway, breathing, and circulation. He subverts this to arterial oxygenation, breathing, and complications. In emergency care of spinal cord injury, a better mnemonic is SABCD. S stands for stabilization, to prevent further injury. ABC should refer to making sure the airway is clear, that the patient is breathing, and that the circulation is sufficient (blood pressure). D stands for spinal cord decompression.

    Dr. Hurlbert is wrong when he said that Christopher Reeve died of a pressure sore. Christopher probably died from anaphylactic response to antibiotic therapy. He is also wrong when he says that there is no Class I evidence that methylprednisolone is ineffective. It is sad that in this day of evidence-based medicine that this doctor repeatedly said clinical trials are not necessary to test therapies or theories that he favors while he dismisses therapies that have been tested in double-blind, randomized, multicenter, placebo-controlled trials published in the best journals.

    However. I am glad that he did a trial of minocycline. But, now that he is doing this trial, I wonder whether he is being as critical of his own data. For example, he did not say whether he stratified his subjects by ASIA classification. If he has more incomplete patients in the minocycline treated group, it could easily account for the data that he has shown. He does not mention the mechanism by which minocycline is neuroprotective or the negative studies that have been published. I wonder why this treatment is not being rushed to multicenter clinical trial?

    Do you happen to know the date of this talk?

    Last edited by Wise Young; 02-01-2012 at 05:15 AM.

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    Spinal Update was held December 13-15, 2011 in Riyadh Saudi Arabia at the College of Medicine (KSU) King Saud University Hospitals. There are 26 various presentations from the conference.

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