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This review found no controlled trials of spinal fixation surgery for the patient group. The quality of the existing evidence is too poor to include in the review, as it is likely to be unreliable. Good quality controlled trials are needed to answer this question.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Spinal cord damage from injury causes long‐term disability and can dramatically affect quality of life. The current practice of immobilising trauma patients before hospitalisation to prevent more damage may not always be necessary, as the likelihood of further damage is small. Means of immobilisation include holding the head in the midline, log rolling the person, the use of backboards and special mattresses, cervical collars, sandbags and straps. These can cause tissue pressure and discomfort, difficulty in swallowing and serious breathing problems.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Spinal cord injury is a serious condition and the effects are usually permanent. In several countries, specialist centres have been set up, where patients can be taken within a few hours of their injury, but even in these countries many patients are dealt with in non‐specialist hospitals. This review tried to answer the question: does immediate referral to an SIC result in a better outcome than delayed referral? However, a comprehensive search failed to find any controlled studies and so it is not yet possible to answer the question. The reviewers call for appropriate research to be done.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Injuries to the spinal cord are often devastating. Worldwide there are up to 40 million such injuries a year. People who survive often have severe disabilities. Gangliosides are substances that occur naturally in nerve cells. They can be manufactured and there have been studies to see whether they can be used to treat various conditions where nerves have been damaged. This review found two studies where a ganglioside had been used to treat people with spinal cord injury. The treatment did not produce a lower death rate and there was no evidence that movement, feeling or quality of life was improved for those who lived.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

After an injury at a high point on the spinal cord (a cervical injury), the muscles responsible for breathing are paralysed or weakened. This weakness reduces the volume of the lungs (lung capacity), the ability to take a deep breath and cough, and puts them at greater risk of lung infection. Just like other muscles of the body, it is possible to train the breathing (respiratory) muscles to be stronger; however, it is not clear if such training is effective for people with a cervical spinal cord injury. This review compared any type of respiratory muscle training with standard care or sham treatments. We reviewed 11 studies (including 212 people with cervical spinal cord injury) and suggested that for people with cervical spinal cord injury there is a small beneficial effect of respiratory muscle training on lung volume and on the strength of the muscles used to take a breath in and to breathe air out and cough. No effect was seen on the maximum amount of air that can be pushed out in one breath, or shortness of breath. An insufficient number of studies had examined the effect of respiratory muscle training on the frequency of lung infections or quality of life, so we could not assess these outcomes in the review. We identified no adverse effects of training the breathing muscles for people with a cervical spinal cord injury.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

A major problem after spinal cord injury is muscle resistance to having the arms or legs moved (spasticity). There can also be spasms. This can severely limit a person's mobility and independence, and can cause pain, muscle problems, and sleep difficulties. Treatments to try and reduce spasticity include exercise, and drugs to try and decrease the muscle tone. The review found there was not enough evidence from trials to assess the effects of the range of drugs used to try and relieve spasticity after spinal cord injury. The authors of the review call for more research and make recommendations as to how this research should be conducted.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

A traumatic spinal cord injury (SCI) is a lesion of neural elements of the spinal cord that can result in any degree of sensory and motor deficit, autonomic or bowel dysfunction. Locomotor training for walking is used in rehabilitation after spinal cord injury (SCI) and might help to improve a person's ability to walk. However, many strategies exist to improve this function, such as treadmill training with and without bodyweight support, robotic‐assisted gait training and electrical stimulation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Every year, about 40 million people worldwide suffer a spinal cord injury. Most of them are young men. The results are often devastating. Various drugs have been given to patients in attempts to reduce the extent of permanent paralysis. Steroids have probably been used more for this purpose than any other type of drug. The review looked for studies that examined the effectiveness of this treatment in improving movement and reducing the death rate. Nearly all the research, seven trials, has involved just one steroid, methylprednisolone. The results show that treatment with this steroid does improve movement but it must start soon after the injury has happened, within no more than eight hours. It should be continued for 24 to 48 hours. Different dose rates of the drug have been given and the so‐called high‐dose rate is the most effective. The treatment does not, however, give back the patient a normal amount of movement and more research is necessary with steroids, possibly combining them with other drugs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Many people living with spinal cord injury (SCI) have chronic pain. Besides pain medication, other treatment possibilities are commonly offered. This systematic review aims to summarise available evidence on the effectiveness and possible side effects of other forms of treatment.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Damage to the nervous system can lead to a lack of co‐ordination (dyssynergia) between the bladder (detrusor) and the muscle at the exit of the bladder that allows people to control their bladder emptying (external urethral sphincter muscle). This urologic condition is called detrusor‐sphincter dyssynergia (DSD) and is most frequently seen in people with spinal cord injury and multiple sclerosis. Insufficient relaxation of the sphincter during a voiding contraction prevents effective bladder emptying and can lead to high pressures in the bladder. People with increased bladder pressures are at an increased risk for bladder and kidney infections, which may lead to kidney damage and even failure.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Individuals with central nervous system disease or injury have a much higher risk of loss of bowel control and severe constipation than other people. This is called neurogenic bowel dysfunction (NBD). It can be very difficult to treat constipation without causing bowel leakage, or to prevent bowel leakage without causing constipation. The time spent on emptying the bowel is nearly always much greater for these individuals. Bowel problems like this cause a lot of anxiety and distress and can reduce the quality of life of those who suffer them. This review of research about NBD could be of interest to individuals with any damage to the central nervous system caused by disease or injury, or present at birth, which has a long term effect on how their bowel works.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

The seven bones making up the neck region of the backbone are called the cervical vertebrae. The first vertebra, called the atlas, supports the skull. Underneath this is the axis or second vertebra, which has a upward pointing process called the odontoid process around which the atlas can rotate, enabling the head to be turned. Fracture of the odontoid process is a serious injury and is often fatal. In survivors there is a risk of ongoing damage to the spinal cord and paralysis. People with these fractures are often treated conservatively, which entails stabilisation of the neck in devices such as a 'Halo' (external frame) and/or rigid collar for several months. Another option is surgical stabilisation of the fractured parts. The review aimed to examine the evidence from randomised controlled trials comparing surgical versus conservative treatment for these fractures to find if either approach gave a better outcome. Despite a comprehensive search, the review authors found no evidence from completed randomised controlled trials to inform the choice between surgical and conservative management.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

The part of the back bone found in the neck is called the cervical spine. It consists of seven bones (or vertebrae). The relative movement of these vertebrae is mainly via small joints (called facet joints) located between each vertebrae. The facet joints in the cervical spine facilitate good movement of the neck, but they are vulnerable to dislocation. Typically, cervical spine facet dislocations are caused by high‐energy traumas such as road traffic accidents or violent attacks. Approximately half of people with such dislocations sustain an injury to the spinal cord carried within the spine. This can result in significant impairment of function (e.g. paralysis). Surgery is usually needed for these serious injuries in order to keep the neck bones in place.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

The thoracolumbar region of the spine is composed of the thoracic (middle back) and lumbar (lower back) spine. One type of spinal injury is the burst fracture where a vertebra (one of several bones making up the spine) is fractured (broken) such that it loses height on both its back and front sides. This sort of fracture occurs most frequently in the bones situated at the junction of the thoracic and lumbar spine. These injuries are usually the result of a high‐velocity accident such as a motor vehicle crash. These are serious injuries, particularly when the spinal cord is also damaged as this may result in the partial or complete loss of sensory and motor function in the legs, and bladder or bowel dysfunction. This review only included people whose nerve tissue was not damaged, although later damage could not be ruled out. People are treated in hospital either conservatively by being placed in a lying position that reduces strain on that part of the spine followed by fitting a cast or brace so that they can move around, or surgically by stabilising the affected part of the spine using various implants and procedures.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Thoracic and lumbar spine fractures are the most common injuries of the spine. An exaggerated curvature (kyphosis) at the end of treatment may predispose to later back pain and a poor functional outcome. If the nerve root or spinal cord is damaged, partial or complete loss of sensory and motor function in the legs, and urinary and faecal incontinence may result. Treatment depends on the individual characteristics of the fracture, with options including bed rest alone, closed reduction of the fracture and functional bracing, and surgery involving open reduction and internal fixation of the fracture. Surgery frequently involves posterior pedicle screw fixation, where typically screws are placed in the 'pedicle' parts of the vertebrae (bones of the spine) adjacent to the damaged vertebrae and connected by rods to hold the bones in place and stabilise the fracture while it heals. This review examined the evidence for the different types of pedicle screw fixation and for additional support such as fusion, where bone graft (usually taken from bone near the hip region of the patient) or substitute is added to the spine. The latter aims to reduce movement of the injured segment and any associated pain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Formation of unwanted blood clots in the deep veins of the legs is a serious and potentially fatal health problem because blood clots in the legs can travel to the lungs and cause death. Unwanted blood clots in legs can occur as the result of reduced mobility (due to surgery, stroke, injuries, etc.), increased tendency for blood clotting (due to cancer, inherited conditions, etc.), and other factors. Formation of unwanted blood clots in the legs can be prevented by pharmacological methods (heparin, warfarin, etc.) or mechanical methods (specific stockings or devices that help to compress the legs to promote flow of blood within the veins, reducing the risk of blood clotting). Neuromuscular electrical stimulation systems (NMES) deliver electrical impulses via electrodes to the skin over selected muscle groups or nerves to induce an involuntary muscle contraction. NMES are thought to be effective as a mechanical method of preventing blood clots in the legs. Therefore, we aimed to identify available evidence on the effectiveness of NMES compared with other methods in preventing formation of unwanted blood clots.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

The optic nerve transmits visual information from the eye to the brain and traumatic optic neuropathy (TON) refers to any injury to the optic nerve secondary to trauma. After the optic nerve has been injured, it becomes more swollen and this can lead to further damage. Traumatic optic neuropathy often results in severe visual loss and the vast majority of affected people are young males in their thirties. Since the early 1980s, steroids have been used in an attempt to reduce the abnormal swelling that follows an injury to the optic nerve and improve visual recovery. However, the role of steroids in TON is controversial and clinicians remain divided over the best management strategy. The recommendations in this review are based on a critical analysis of the available evidence in the medical literature. We found only one, relatively small, randomised controlled trial of steroids in TON, which included 31 participants within seven days of their initial injury. These participants received either high dose intravenous steroids (n = 16) or placebo (n = 15). At three months follow‐up, no significant difference in best corrected visual acuity was found between these two groups. There is a relatively high rate of spontaneous visual recovery in TON and no convincing data that steroids provide any additional benefit over observation alone. Each case needs to be assessed on an individual basis and the patient needs to be made fully aware of the possibility of a serious adverse reaction, although rare, to steroids. Furthermore, recent studies have highlighted possible detrimental effects of steroids when used in brain and spinal cord injuries and these new lines of evidence need to be considered seriously.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

We reviewed the evidence about the effect of anabolic steroids (medicines designed to increase muscle mass) for treating people with pressure ulcers.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: June 20, 2017

Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are wounds involving the skin and sometimes the tissue that lies underneath. Pressure ulcers can be painful, may become infected, and so affect people's quality of life. People at risk of developing pressure ulcers include those with spinal cord injuries, and those who are immobile or who have limited mobility ‐ such as elderly people and people who are ill as a result of short‐term or long‐term medical conditions.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

We reviewed the evidence about the effects of dressings and topical agents (such as ointments, creams and gels) on pressure ulcer healing. There are many different dressings and topical agents available, and we wanted to find out which were the most effective.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: June 22, 2017

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