Spinal Cord Injuries in Combat

[JMH85]

How do you deal with Spinal Cord Injuries in a tactical situation? Say the mountainous regions of Afghanistan. Would the drugs serve any use in a tactical scenario until you can get to a hospital?

I found this information, so I figured I would share it with everybody. Granted, I doubt this includes gunshot wounds to the spine, but here it is anyway.

Spinal Cord Injury Information: Spinal Cord Link (http://www.spinalcord.org/html/factsheets/cure.php)

Research has shown that all damage in SCI does not occur instantaneously. Mechanical disruption of nerves and nerve fibers occurs at the time of injury. Within 30 minutes, hemorrhaging is observed in the damaged area of the spinal cord and this may expand over the next few hours. By several hours, inflammatory cells enter the area of spinal cord injury and their secretions cause chemical changes that can further damage nervous tissue. Cellular content of nerve cells killed by the injury contribute to this harmful chemical environment. This process may go on for days or even weeks.

Hope lies, therefore, in treatments that could prevent these stages of progressive damage. Drugs that protect nerve cells following injury are now available to lessen the severity of some injuries. Other drugs and combinations of drugs are currently being tested in both animal and clinical trials.

Types of Drugs being tested:

Methylprednisolone

Methylprednisolone is effective only if used in high doses within eight hours of acute injury. It is hypothesized that this drug reduces damage caused by the inflammation of the injured spinal cord and the bursting open of the damaged cells. The contents of the damaged cells are believed to adversely affect adjacent cells. High doses of methylprednisolone can lead to side effects, such as suppression of the immune system, but no serious problems have been reported when it is used over a short term as in this study.

Tirilizade

Similar positive results to those of methylprednisolone have been achieved in animal studies using another steroid, tirilizade mesylate (Freedox®). This drug, which acts like methylprednisolone, also appears to be effective only if administered within a few hours after injury. From initial animal studies, it appears that this drug may cause less side effects than methylprednisolone. Clinical trials are ongoing.

GM-1 Ganglioside

...In a small study, the experimental drug Sygen®, or GM-1 Ganglioside, was given within 72 hours of injury and then continued for up to 32 days. Neurological assessments were conducted up to one year after the treatment. Individuals who received Sygen®showed significantly more functional recovery...There are two theories about how GM-1 Ganglioside may act on spinal cord tissue. The first is that it performs some type of damage control by reducing the toxicity of amino acids released after spinal cord tissue is injured. The "excitatory" amino acids cause cells to die and increase the damage caused by the initial injury. The second theory suggests there may be a neurotrophic effect, somehow encouraging the growth of injured neurons. Neither of these theories have been scientifically proven yet.


Respectfully,

JMH85

[The Reaper]

On a related note, they used a hyperbaric chamber when GEN Shelton fell off a ladder and broke his back.

His recovery has been exceptional, but all cases are different.

IMHO, in a combat zone, you are more likely to see spinal injury in conjunction with other trauma than in isolation, and further injury may be caused treating more immediate life-threating injuries or removing the patient from the hazard.

Just my .02, YMMV.

TR

[swatsurgeon]

the literature on steroids was greatly flawed but somehow accepted in the past. The only reason it still is given is the medicolegal nightmare it would cause until the literature PROVES it doesn't work...a scientific study in reverse...I predict this will no longer be used within the next 2-3 yrs.
The problem with any SCI is the need for immobility and in a tactical or under fire scenerio, it would be difficult, if not impossible to do no further harm when trying to evac someone out from a hot zone.
The hope lies in the future with either genetic re-engineering or stem cells that can fix the damage....trying to prevent more damage carrying someone out from a firefight, good luck, they'll be alive but likely with increased cord injury. Unless they can remain behind hard cover until they can be properly immobilized, there is a great risk.
ss

[Razor]

Are you asking if military medical professionals have these steroids available at higher-echelon care facilities, or if there are military doctors trained in neurology and orthopedics to care for SCI patients?

[JMH85]

Razor, I'm just asking how you deal with SCI patients in combat. I was looking around on the Internet and found the info I posted and wanted to see if the drugs (only if they worked) would be a reliable care method in combat until the patient could be sent to a hospital.

JMH

[JMH85]

On a related note, they used a hyperbaric chamber when GEN Shelton fell off a ladder and broke his back.

His recovery has been exceptional, but all cases are different.

IMHO, in a combat zone, you are more likely to see spinal injury in conjunction with other trauma than in isolation, and further injury may be caused treating more immediate life-threating injuries or removing the patient from the hazard.

Just my .02, YMMV.

TR


Interesting, Thanks TR


SS-

I figured any movement would do more harm than good, but figured the Docs had a solution for everything. Thanks.


JMH

[DoctorDoom]

x

[Razor]

If I'm not mistaken, those drugs are not something your team medic would be hauling around in his aid bag, but rather are held at hospital-level facilities for use in a stabilized (relative term there) environment. FWIW, I know for sure Methylprednisolone has been around and used for immediate treatment for SCI since at least 1997, so these aren't necessarily new wonder drugs, nor have they been proven to do much good. Like SwatSurg said, the real advances lie in the fields of tissue implantation/replacement, and the very complex chemical soup (growth inhibitors, growth facilitators, calcium control) that controls regeneration and repair in the CNS.

[JMH85]

Thanks Razor. It was new to me and seemed interesting enough so I thought I would see what the Docs and everybody else around here had to say about it.

JMH85

[jasonglh]

My level of neither education nor experience is nowhere near on par with most of the posters here yet but if I may ask.

If we are talking trauma involving central spinal cord injury in a battlefield setting not someone in a fall type accident or mva would not high doses of steroids increase the risk of infection?

I do not have experience in battlefield ems but as I understand it would entail bandaging as cleanly as possible and treating possible infection in the rear with antibiotics after debridment. High doses of Solu-Medrol would lower the immune system in the patient.

[LeakyBandage]

the literature on steroids was greatly flawed but somehow accepted in the past. The only reason it still is given is the medicolegal nightmare it would cause until the literature PROVES it doesn't work...a scientific study in reverse...I predict this will no longer be used within the next 2-3 yrs...

More material: http://www.trauma.org/spine/steroids.html
http://beta.trauma.org/traumawiki/index.php?title=Steroids_for_SCI_open_letter

[Tubbs]

In my experience you may not even notice that you have a SCI in a combat situation just based on how intense of a situation you are in and how mentally tough you are.
My spine was injured in Iraq and I didn't even know it until a few months of chronic unexplained pain later I lost feeling to the lower half of my body during PT and got sent in for an MRI.
Treatment then consisted of some Physical Therapy that centered around strengthening certain core muscles.

[Razor]

Or, it could be severe enough to create instantaneous loss of motor and sensory function. Should that happen, you'll be very aware of injury rather quickly.

Tubbs, did you have a spinal cord injury, or an impingment on peripheral nerves caused by damage to the spinal column?

[Tubbs]

I sustained injuries to my vertebre which resulted in several fractures. This lead to a disk slipage and inflamamtion. This in turn lead to nerve impingement.
Officially I now have spondyliothesis... or some such nonsense.