Traumatic spinal injury and spinal cord injury: point for active physiological conservative management as compared to surgical management

Spinal Cord Series and Cases
W S El Masri Y

Abstract

The controversy about surgical vs conservative treatment of the injured spine with cord damage is centuries old. Until the end of the Second World War the majority of patients died or lived a short miserable life. Subsequently, Guttmann, an experienced neurosurgeon, realised surgery was not beneficial and sometimes detrimental to the person with spinal cord injury. Guttman, Frankel and others demonstrated with expert conservative management of the spine and the multi-system consequences of cord damage most patients made some neurological recovery and most with incomplete cord injury recovered ambulation regardless of X-ray findings. Attention to the non-medical effects of paralysis and post discharge supervision enabled persons with SCIs to enjoy complication free, dignified, productive and even competitive lives in sport and employment. The introduction of CT, MRI and safe anaesthesia led to the beliefs that surgical realignment, stabilisation and/or decompression improved neurologic outcome, facilitated early mobilisation and completion of rehabilitation, shortened hospitalisation, facilitated management and reduced cost. However, there is no supporting evidence for these claims. This manuscript describes the rationale and ou...Continue Reading

References

Mar 1, 1989·Injury·Y Folman, W el Masri
Nov 1, 1988·The Journal of Bone and Joint Surgery. British Volume·M W Fidler
Mar 1, 1987·Journal of Neurosurgery·L F MarshallG L Clifton
Feb 1, 1996·Journal of Neurology, Neurosurgery, and Psychiatry·W S el Masry, A Biyani
Dec 11, 1997·The Journal of Bone and Joint Surgery. British Volume·A R PoyntonM G Walsh
Mar 7, 1998·Current Opinion in Neurology·W S el Masry, D J Short
Feb 16, 2000·The American Journal of Emergency Medicine·J D ApfelbaumN Waldman
Apr 25, 2006·Lancet Neurology·Ahmed IbrahimWagih S El Masry

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Citations

Oct 2, 2019·The Journal of Spinal Cord Medicine·Chip P RowanB Catharine Craven
Jan 1, 2020·British Journal of Neurosurgery·Fardad T AfshariAntonino Russo
Feb 19, 2019·Spinal Cord Series and Cases·Augustine Abiodun AdeoluMatthew Temitayo Shokunbi
May 28, 2019·BJR Case Reports·Mai A Mostafa
Nov 28, 2018·Spinal Cord Series and Cases·Anup K GangavalliGbolabo Sokunbi
Jun 29, 2018·Spinal Cord Series and Cases·Marcalee Alexander
Dec 2, 2020·Spinal Cord Series and Cases·Manoj K Poudel, Andrew L Sherman

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