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Thread: Medical question for Dr. Wise...

  1. #1

    Medical question for Dr. Wise...

    At the time of my son's accident and hospitalization, we were told by the doctors and nurses that we needed to wait for several weeks for all of the swelling to go down and they would know then how much function was remaining after the surgery. He had rods and screws put in for compression fracture at C5-7 and fracture at L1-2 which was never repaired... surgery was 10 hours long...etc. We often wonder now why no special efforts were done to reduce this swelling. I've never seen much literature on research concerning the need to stop all of the swelling...but it would seem that all the additional swelling in the spinal cord would not be helping stop the damage being done to the nerves.

    My son has asked me if it doesn't make sense to try to stop as much swelling as possible in order to decrease the ongoing damage from persistant swelling in the injured area. (Somewhat like getting ice to a sprained ankle...) He was wondering if it would be possible to insert a temporary cooling tube for a couple of weeks in the area and remove it when the threat of swelling subsided... Does this question make sense to you? We have not been able to find much information about increased efforts to control swelling during the repair of SCI in surgery and recovery.

    Grammy

  2. #2
    Did he get high dose methyprednisilone therapy immediately upon his injury? This helps a lot to control edema.

    Dr. Young may have more to say about icing, but intraoperative icing was tried in a number of studies that I remember back in the 1970s and early 1980s, and at that time showed not benefit, but came with significant risks (infection, increased spinal instability due to the wide laminectomies needed, etc.). Dr Young may know about more recent studies. I will ask him to comment.

    (KLD)

  3. #3
    Quote Originally Posted by GRAMMY
    At the time of my son's accident and hospitalization, we were told by the doctors and nurses that we needed to wait for several weeks for all of the swelling to go down and they would know then how much function was remaining after the surgery. He had rods and screws put in for compression fracture at C5-7 and fracture at L1-2 which was never repaired... surgery was 10 hours long...etc. We often wonder now why no special efforts were done to reduce this swelling. I've never seen much literature on research concerning the need to stop all of the swelling...but it would seem that all the additional swelling in the spinal cord would not be helping stop the damage being done to the nerves.

    My son has asked me if it doesn't make sense to try to stop as much swelling as possible in order to decrease the ongoing damage from persistant swelling in the injured area. (Somewhat like getting ice to a sprained ankle...) He was wondering if it would be possible to insert a temporary cooling tube for a couple of weeks in the area and remove it when the threat of swelling subsided... Does this question make sense to you? We have not been able to find much information about increased efforts to control swelling during the repair of SCI in surgery and recovery.

    Grammy
    Great questions. I agree with KLD that high-dose methylprednisolone (a steroid) reduces swelling in the spinal cord. In the early 1980's, we had shown that methylprednisolone increases blood flow and reduces edema at the injury site of cat spinal cords.

    In a clinical trial published in 1990 (called the Second National Acute Spinal Cord Injury Study or NASCIS 2 study), we showed that if methylprednisolone is given to people within 8 hours after injury, they recovered an average of 20% more function than people that did not receive the drug.

    Regarding cooling of the spinal cord, this was tried and shown to be beneficial in animals. In fact, a neurosurgeon by the name of Bob Hansebout in Canada actually tried doing a combination of methylprednisolone and cooling of the spinal cord in the early 1980's and reported that this was beneficial.

    By the way, the technical term for such cooling is "hypothermia" and you can so a google search for "spinal cord hypothermia steroids" to find out more information about the subject. Note that one clinical trial by Guy Clifton in Texas several years ago suggestd that whole body hypothermia was not effective but there have been suggestions for clinical trials of local hypothermia.

    Wise.

  4. #4

    Unhappy This is exactly the treatment I asked Dr Wise about...

    We recently asked Dr Wise about the hypothermia treatment that appears to have been given to the NFL football player. Dr. from Miami Project was just on MSNBC and stated they know this helps as they have been using it over the past year, but have not suggested and made any announcements for it to become a protocol for all tramatic SCI victims!

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