Table Of ContentF
Essentials of
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g Spinal Cord Injury
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The definitive guide to putting spinal cord
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injury research into clinical practice l Basic Research to Clinical Practice
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Essentials of Spinal Cord Injury is written for the spinal cord injury (SCI) team and reflects E Michael G. Fehlings
the multidisciplinary nature of treating patients with SCI. It integrates emerging medical s
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and surgical approaches to SCI with neuroanatomy, neurophysiology, neuroimaging, e Alexander R. Vaccaro
neuroplasticity, and cellular transplantation. This comprehensive yet concise reference n
will enable neurosurgeons, orthopedic surgeons, neurologists, and allied health professionals t Maxwell Boakye
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caring for SCI patients to translate research results into patient care. It is also an excellent a
Serge Rossignol
resource for those preparing for the board exam in SCI medicine. ls
Key Features: o John F. Ditunno, Jr.
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• Material is cross-referenced to highlight relationships between the different areas of SCI
S Anthony S. Burns
• Chapters are concise, focused, and include key points, pearls, and pitfalls
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• An Overview of the Literature table is provided in most chapters, giving readers a meaningful
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distillation of each publication referenced n
• Each editor is a world-renowned expert in one of these core disciplines involved in the a
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management of SCI patients: neurosurgery, orthopedic surgery, spinal cord science, and
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rehabilitative medicine
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This is a must-have guide that all neurosurgeons, orthopedic surgeons, neurologists, and allied r
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health professionals involved in the care of SCI patients should have on their bookshelf—they
will repeatedly refer to it in the course of their practice. I
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Michael G. Fehlings, MD, PhD, FRCSC, FACS, University of Toronto and Krembil Neuroscience u
Center, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada. r
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Alexander R. Vaccaro, MD, PhD, Delaware Valley Spinal Cord Injury Center and Thomas
Jefferson University, The Rothman Institute, Philadelphia, Pennsylvania.
Maxwell Boakye, MD, MPH, FACS, Center for Advanced Neurosurgery at the University of
Louisville and Robley Rex VA Hospital, Louisville, Kentucky.
Serge Rossignol, MD, PhD, Groupe de Recherche sur le Système Nerveux Central (FRSQ),
Université de Montréal, Montréal, Canada.
John Ditunno, MD, The Regional Spinal Cord Injury Center of the Delaware Valley, Jefferson
Medical Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania.
Anthony Burns, MD, MSc, University of Toronto, Toronto Rehabilitation Institute University
Health Network, Toronto, Ontario, Canada.
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ISBN 978-1-60406-726-2
9 781604 067262 www.thieme.com
Essentials of Spinal Cord Injury
Basic Research to Clinical Practice
Essentials of Spinal Cord Injury
Basic Research to Clinical Practice
Michael G. Fehlings, MD, PhD, FRCSC, FACS Alexander R. Vaccaro, MD, PhD
Professor of Neurosurgery The Everrett J. and Marion Gordon Professor
Gerald and Tootsie Halbert Chair in Neural of Orthopaedic Surgery
Repair and Regeneration Professor of Neurosurgery
Director, Neuroscience Program Co-Director, The Regional Spinal Cord Injury
Co-Chairman, Spinal Program Center of the Delaware Valley
University of Toronto Co-Chief, Spine Surgery
Medical Director Co-Director, Spine Fellowship Program
Krembil Neuroscience Centre Thomas Jefferson University
Toronto Western Hospital The Rothman Institute
University Health Network Philadelphia, Pennsylvania
Toronto. Ontario, Canada
Serge Rossignol, MD, PhD
Maxwell Boakye, MD, MPH, FACS Department of Physiology
Ole A., Mabel Wise, and Wilma Wise Nelson Groupe de Recherche sur le Système Nerveux
Endowed Research Chair Central (FRSQ)
Associate Professor of Neurosurgery Canada Research Chair on the Spinal Cord
Center for Advanced Neurosurgery Université de Montréal
University of Louisville SensoriMotor Rehabiltation Research Team
Attending Neurosurgeon of the CIHR
Robley Rex VA Hospital Montreal, Quebec, Canada
Louisville, Kentucky
Anthony S. Burns, MD, MSc
John F. Ditunno Jr., MD Associate Professor
Professor Division of Physiatry
Department of Rehabilitation Medicine Department of Medicine
Emeritus Director University of Toronto
The Regional Spinal Cord Injury Center of the Toronto Rehabilitation Institute
Delaware Valley University Health Network
Thomas Jefferson University Toronto, Ontario, Canada
Philadelphia, Pennsylvania
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Library of Congress Cataloging-in-Publication Data
Essentials of spinal cord injury : basic research to clinical practice / [edited by] Michael G. Fehlings ...
[et al.].
p. ; cm.
Includes bibliographical references.
ISBN 978-1-60406-726-2 (alk. paper)—ISBN 978-1-60406-727-9 (eISBN)
I. Fehlings, Michael.
[DNLM: 1. Spinal Cord Injuries. WL 403]
617.4′82044—dc23
2012016863
Copyright © 2013 by Thieme Medical Publishers, Inc. This book, including all parts thereof, is legally
protected by copyright. Any use, exploitation, or commercialization outside the narrow limits set by
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preparation of microfilms, and electronic data processing and storage.
Important note: Medical knowledge is ever-changing. As new research and clinical experience broaden
our knowledge, changes in treatment and drug therapy may be required. The authors and editors of the
material herein have consulted sources believed to be reliable in their efforts to provide information that
is complete and in accord with the standards accepted at the time of publication. However, in view of the
possibility of human error by the authors, editors, or publisher of the work herein or changes in medical
knowledge, neither the authors, editors, nor publisher, nor any other party who has been involved in the
preparation of this work, warrants that the information contained herein is in every respect accurate
or complete, and they are not responsible for any errors or omissions or for the results obtained from
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Some of the product names, patents, and registered designs referred to in this book are in fact registered
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Printed in China
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ISBN 978-1-60406-726-2
eISBN 978-1-60406-727-9
I would like to dedicate this book to my family, colleagues, students, and patients.
Michael G. Fehlings
My greatest thanks go to all my patients whom I have met throughout the years with spinal
cord injury who have educated me during their journey through treatment and rehabilitation.
Alexander R. Vaccaro
To my wife, Petrina, for her love, kindness, patience, understanding, and support, and without
whom this would not have been possible. To my children, Kwame and Amie, for being fun and
making this worthwhile. To my parents for all their sacrifices for me: my late father Kwaku for
being the greatest dad and my hero, and my mother, Alice, for being the greatest mom with her
encouragement and enduring support.
Maxwell Boakye
To my students and colleagues who have constantly renewed my interest in spinal cord re-
search and to my family who endorsed the crazy schedule needed for this work. I acknowledge
also the funding organizations, such as the Canadian Institute for Health Research (CIHR), that
have unfailingly supported my research throughout these years.
Serge Rossignol
It has been and continues to be a privilege to work in such an amazing and stimulating field.
We admire the many individuals whose care we have had the opportunity to participate in and
are thankful to the many colleagues, teachers, and mentors whom we have had the opportu-
nity to work with over the years.
Anthony S. Burns and John F. Ditunno Jr.
Contents
Foreword .............................................................................................................................. xi
Preface ................................................................................................................................... xiii
Contributors ........................................................................................................................ xv
I Principles of Spinal Cord Injury Clinical Practice
1 Anatomy and Physiology of the Spinal Cord ..................................................................... 3
Serge Rossignol
2 Evaluation of the Patient with Spinal Cord Injury .......................................................... 18
Mahmoud Benour, Aleksa Cenic, R. John Hurlbert, and Charles H. Tator
3 Imaging of Acute Spinal Cord Trauma and Spinal Cord Injury .................................... 27
David W. Cadotte, David J. Mikulis, Patrick Stroman, and Michael G. Fehlings
4 Pathophysiology of Spinal Cord Injury ............................................................................... 38
James W. Austin, James W. Rowland, and Michael G. Fehlings
5 Epidemiology of Traumatic Spinal Cord Injury ................................................................ 56
Yuying Chen
6 Spinal Cord Injury Classification .......................................................................................... 65
Sonia Teufack, James S. Harrop, and Ashwini D. Sharan
7 Spontaneous Recovery Patterns and Prognoses after Spinal Cord Injury ............... 75
Doniel Drazin and Maxwell Boakye
8 Management of Spinal Cord Injury in the Intensive Care Unit ................................... 84
Nicolas Phan
9 Concomitant Traumatic Brain Injury and Spinal Cord Injury ...................................... 98
Daniel C. Lu, Nicolas Phan, Michael S. Beattie, and Geoffrey T. Manley
10 Pharmacotherapy in Acute Spinal Cord Injury: Focus on Steroids ............................ 108
Edward M. Marchan, George Ghobrial, Benjamin M. Zussman, James S. Harrop,
and Alpesh A. Patel
11 Halo Application and Closed Skeletal Reduction of Cervical Dislocations .............. 117
Scott D. Daffner
12 Principles of Surgical Management of Spinal Trauma Associated with
Spinal Cord Injury ..................................................................................................................... 124
Toba N. Niazi, Michael Daubs, and Andrew T. Dailey
13 Venous Thromboembolism Prophylaxis ............................................................................ 135
Avraam Ploumis
14 Sexuality and Fertility after Spinal Cord Injury ............................................................... 143
Stacy L. Elliott
15 Interdisciplinary Essentials in Pressure Ulcer Management ....................................... 158
Kath Bogie, Chester Ho, Monique Washington, Sharon Foster-Geeter,
J. C. Seton, Steven J. Mitchell, Martin J. Kilbane, Gina L. D. Kubec, Kimberly Sexton,
Thomas M. Dixon, Christine C. Frick, and Joshua L. White
16 Autonomic Dysreflexia and Cardiovascular Complications of Spinal
Cord Injury ................................................................................................................................... 181
Andrei Krassioukov
17 Pain after Spinal Cord Injury ................................................................................................. 195
Angela Mailis and Luis Enrique Chaparro
18 Essentials of Spinal Cord Injury: Psychosocial Aspects of Spinal Cord Injury ........ 205
Paul Kennedy and Emilie F. Smithson
19 Posttraumatic Kyphotic Deformity of the Cervical Spine ............................................ 213
Kris E. Radcliff, David Gendelberg, Gurusukhman D. S. Sidhu, and
Alexander R. Vaccaro
20 Posttraumatic Syringomyelia: Pathophysiology and Management .......................... 224
Mohammed Farid Shamji, Sung-Joo Yuh, and Eve C. Tsai
21 Rehabilitation of the Individual with Spinal Cord Injury ............................................. 235
Aria Fallah, Derry Dance, and Anthony S. Burns
22 The Management of Secondary Complications Following Spinal Cord Injury ....... 244
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C II Controversies in Management
23 Timing of Surgery for Acute Spinal Cord Injury: From Basic Science to
Clinical Application ................................................................................................................... 265
David W. Cadotte and Michael G. Fehlings
24 Hypothermia: Evidence-Based Review .............................................................................. 291
David M. Benglis Jr., Allan D. Levi, and Michael Y. Wang
25 Management of Cervical Facet Dislocation ....................................................................... 308
Ishaq Y. Syed and Joon Y. Lee
26 Management of Acute Spinal Cord Injury in Thoracolumbar Burst Fractures
Including Cauda Equina Syndrome ..................................................................................... 320
Marcel F. Dvorak and Brian Lenehan
27 Management of Central Cord Syndrome............................................................................ 329
Harvey E. Smith and Todd J. Albert
III Neuroprotective and Neuroregenerative Approaches
28 Research in Spinal Cord Injury: Building an Effective Translational
Research Program ..................................................................................................................... 339
W. Dalton Dietrich
viii
29 North American Clinical Trials Network: Building a Clinical Trials
Network for Spinal Cord Injury ............................................................................................ 348
Robert G. Grossman, Elizabeth G. Toups, Ralph F. Frankowski, Keith D. Burau,
and Susan P. Howley for the NACTN Investigators
30 Considerations for the Initiation and Conduct of Spinal Cord Injury
Clinical Trials ............................................................................................................................... 356
John D. Steeves
31 Animal Models of Spinal Cord Injury .................................................................................. 366
Aileen J. Anderson, Sheri L. Peterson, and Christopher J. Sontag
32 Glial Scar and Monocyte-Derived Macrophages Are Needed for Spinal
Cord Repair: Timing, Location, and Level as Critical Factors ....................................... 378
Michal Schwartz and Ravid Shechter
33 Promising Preclinical Pharmacological Approaches to Spinal Cord Injury ............. 391
Michael S. Beattie and Jacqueline C. Bresnahan
34 Cellular Transplantation in Spinal Cord Injury................................................................. 399
Wolfram Tetzlaff
35 Neuroregeneration Approaches ............................................................................................ 411
Lisa McKerracher, Michael G. Fehlings, Alyson Fournier, and Stephan Ong Tone
36 Neuroprotective Trials in Spinal Cord Injury .................................................................... 421
Shelly Wang, Gregory W. J. Hawryluk, and Michael G. Fehlings
37 Approaches Using Biomaterials for Tissue Engineering ................................................ 431
Catherine E. Kang, Howard Kim, Violeta Talpag, and Molly Sandra Shoichet
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IV Neurophysiology and Imaging n
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38 Electrophysiological Measures after Spinal Cord Injury ............................................... 443 o
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James Xie and Maxwell Boakye
39 Quantitative Tests of Sensory, Motor, and Autonomic Function ................................ 453
Peter H. Ellaway
40 Basic Neurophysiological Approaches to Probing Spinal Circuits.............................. 462
Rose Katz and Jean-Charles Lamy
41 Neuroimaging after Spinal Cord Injury: Evaluating Injury Severity and
Prognosis Using Magnetic Resonance Imaging ................................................................ 472
Maxwell Boakye
42 The Role of Neurophysiology in the Study of Recovery and Spasticity .................... 481
Jens Bo Nielsen
V Plasticity and Recovery
43 Spinal and Supraspinal Plasticity after Spinal Cord Injury .......................................... 489
Serge Rossignol and Alain Frigon
44 The Human Central Pattern Generator and Its Role in Spinal Cord
Injury Recovery .......................................................................................................................... 502
Volker Dietz
ix
