Evolution of treatment of spinal cord injury and brain damage

Written by: Dr. Joan Vidal Samsó
Edited by: Top Doctors®

Spinal cord injury ( LM ) is one of the most catastrophic events and covering more serious repercussions, not only in the personal realm but also in healthcare, employment and economic. Furthermore, in cases lamayoria happens unpredictably, producing a loss of motor and sensory functions usually are usually permanent and irreversible and the patient causing partial or complete paralysis of the limbs, loss of sensation below the level of the lesion, lack of control over the sphincters, alterations in sexual sphere and a risk of serious lifelong complications.

In Spain the incidence of traumatic LM is about 20-25 new cases per year per million population, which is that about every year around 1,000-1,500 people suffer a severe spinal cord injury who causing serious neurological sequelae. Of all the injuries that occur, 50% are due to traffic accidents and mostly affect men, with 80 % of cases, compared with 20 % of women and, regardless of sex, more than half are young people under 30 years.

In this number of traumatic lesions origin must add 30-40 % more medical origin ( myelitis, tumors, medullary infarcts, and so on ), which increases the number of spinal injuries to a number next to the 2,000 new cases annually.

Traffic accidents are one of the most important causes of mortality in the Western world, and in Spain ranks fourth in incidence, behind cardiovascular diseases, neoplasms and respiratory diseases. Also, are the leading cause of death among men under 34 years and among women under 24 years.


A little history

Centuries has sought to address the serious consequences of a spinal cord injury and many ancient scientific writings have described different aspects. Among the documents are the famous Edwin Smith papyrus, written makes 5,000 years by an Egyptian physician, where it described, in great detail, the symptoms of spinal cord injury in cervical level dislocation or vertebral fracture:“complete paralysis of the four limbs, lack of sensation, loss of bladder control, priapism and seminal ejaculation involuntary&rdquo ;. Even mention a phenomenon is to conjunctival congestion of today know that a vasodilatation is due to paralysis of the vasomotor control in high neck and back injuries. In regard to treatment and prognosis of the injury, the author concludes the text with a meaningful phrase.&Rdquo, a condition that can not be treated”

This defeatist attitude has persisted over many centuries in the minds of medical professionals. Oh surgeons during World War I, clearly describing the tragic fate of the war wounded with lesionesmedulares: 80% memory during the first two weeks. Only they survived incomplete injuries. Most spinal cord injuries who survived had a tragic life, no hope, no work and conmultiples complications from society.

Treatment of spinal cord injuries has undergone major changes in the last 60 years, going from a situation of hopeless mortality by more than 80 % of people who were suffering a core injury to the current situation in which, thanks to advances in medical and surgical, the mortality rates of these patients have decreased, approaching the values ​​of the general population.

It was not until 1943 when the British government commissioned Dr. Sir Ludwig Guttmann, a German neurosurgeon Jewish confession, the organization of the first Spinal Cord Injury Unit at the Hospital of the Ministry of Pensions of Stoke Mandeville, Aylesbury, near London, as sanitary preparation ahead of the World War II, as a large number of wounded foresaw.

It opened on February 1, 1944 with 26 beds, introducing the concept, valid until today, to give people with spinal injuries, paraplegics and quadriplegics, comprehensive care based on the full support from the moment of the establishment of the injury to hospital discharge and reintegration into the community as useful people to society. The main objective was not only to prevent his death from complications, but also give them a reason for overcoming his disability. In short, the patient had to be treated comprehensively by a multidisciplinary team to look after not only the medical aspects, but also the psychosocial aspects essential for successful social reintegration home.

At the end of the war, the Hospital Stoke Mandeville and had 100 beds and was increasing progressively the number of hospital beds, to date, that has more than 200 beds for interdisciplinary care of spinal injuries, both traumatic origin and medical origin.

From the medical and surgical advances introduced by Dr. Guttmann, many monographs centers developed, both in Europe and in Australia and the United States as well as elsewhere in the world.

In the United States, the group of Munro, ComArr, Bors and Talbot undertook the organization of different units for a comprehensive approach to patient with spinal cord injury in the late 40s. Donald Munro, former neurosurgeon at Boston City Hospital, performed many contributions are still valid today, as rhizotomy for the treatment of severe spasticity resistant to traditional treatments. The Veterans Administration (Veteran Administration) created the first units for the care of spinal injuries in Military Veterans Hospitals. Today, in this country a model of specialized care, organized by the UAB -SCI Data Management Service in Alabama, certifying, periodically, to hospitals specializing in the management and treatment of people who have been there is a paraplegia or quadriplegia.

In Europe, first units were formed at the 60, in Germany, Austria, Belgium, France, Holland, Italy and Switzerland. In our country, the first hospital of SCI was founded in Barcelona on November 27, 1965, by Guillermo Gonzalez Gilbey, a quadriplegic patient who was treated at an early stage in Stoke Mandeville. The new hospital in Barcelona received the name of Institut Guttmann, in honor of Dr. Guttmann, and settled on a venereal disease hospital in very poor condition and had to be renovated to house a center for paraplegics autonomous. Its first director was Dr. Miguel Sarrias Sunday, orthopedic surgeon and former disciple of Ludwig Guttmann, and the unit started to operate with 25 beds, up to 96 beds, maximum capacity of the building. Subsequently, in May 2002, the current Institut Guttmann Neurorehabilitation Hospital was opened in Badalona, ​​a hospital with over 150 beds, half of them devoted to the care of spinal cord injuries and the other half to the treatment of the sequelae of injury both traumatic brain as traumatic.

Subsequently, other units along the Spanish geography and a new center in Toledo, Paraplejicos National Hospital with over 200 beds, opened in 1974 created. And today, in the Spanish state there are two centers and eleven monographs units specialized in the treatment of LM, integrated into general hospitals within the Rehabilitation Services.

*Translated with Google translator. We apologize for any imperfection

By Dr. Joan Vidal Samsó
Physical Medicine and Rehabilitation

Dr. Vidal Samsó is a leader in the specialty of Physical Medicine and Rehabilitation. Head of the Spinal Cord Injury Unit of the Institut Guttmann de Barcelona, ​​and s expert in the treatment of neuropathic pain and spasticity, including Baclofen pumps. It also specializes in sex, erectile dysfunction and Assisted Reproduction techniques, physiological adaptation and metabolic changes in the injured spinal cord. He is vice president of the Spanish Society of Paraplegia since 2004 and Spanish representative in the International Society of Paraplegia since 2006.

*Translated with Google translator. We apologize for any imperfection

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