Acute Traumatic Spinal Cord and Cauda Equina Injuries (ATSCCEI): Evidence based outcomes of the traditional model of service delivery and methods of management

Title : Acute Traumatic Spinal Cord and Cauda Equina Injuries (ATSCCEI): Evidence based outcomes of the traditional model of service delivery and methods of management

Abstract:

Acute Traumatic spinal cord injuries (ATSCCEI) is the rarest of all catastrophic life threatening and life changing injuries. They result in a wide range of complex medical, psychological, social, matrimonial, vocational, financial and environmental potentially devastating effects that impact on the cost of treatment and support of the patient. Fortunately the incidence of ATSCCEI is very low and ranges between 1-5 patients/100,000 population/year. Prior to the second WW the great majority of patients died within one year of injury from systemic complications. Death was due to the combination of a small incidence, an unstable multi-system physiological impairment and malfunction, sensory impairment or loss inability that resulted from the loss or impairment of normal sensation as well as the unfamiliarity of Clinicians with the complexity of the condition and the management of the patients. Currently the management of this combination of the wide ranging complex effects of ATSCCEI continue to present significant challenges to Clinicians and Health Care Professionals who are not trained in this field of medicine and who are not familiar with the manage large number of patients from the early hours or days of injury. Patients are especially vulnerable to developing complications during the transitional phase between the loss of autonomic and spinal reflexes and the return of these reflexes. This transitional phase can last up to three months from injury. The management of each of the affected systems of the body during this transitional period requires regular adequate modulation. During the 2nd WW, Ludwig Guttmann (neurosurgeon) and his colleagues demonstrated that with adequate expert care of the effects of ATSCCEI from the early hours or days of injury, patients are able to survive and lead healthy, enjoyable, dignified, fulfilling, productive and often independent and competitive lives. In 1969 Frankel et al demonstrated that patients treated with what can be described as a holistic active physiological conservative management (APCM) of the spinal bony injury together with the medical and non-medical effects of the TSCCEI from the early hours of days of injury can exhibit significant degrees of neurological and functional recovery that can minimise or prevent disability. Significantly they documented the predictors of neurological recovery which was achieved irrespective of the severity of the X-Rays of the injured bony spine. I will discuss the outcomes of the Traditional Model of Service Delivery and Methods of Management and the impact of the change from a Holistic APCM of the injury and its effects as well as the damage caused by the subsequent fragmentation of Model of Service Delivery giving priority to a radiologically based interventional management of the injury.

Biography:

WEM trained in the speciality of spinal injuries at Stoke Mandeville, Oxford, Guys Hospitals & the USA between 1971 and 1983 .To date he personally treated 10,000 patients with traumatic Spinal & Spinal ord Injuries. WEM developed, and led the Midland Centre for Spinal Injuries (MCSI) between 1983 & 2014. He took responsibility for the management of the injured spine, the multisystem malfunction as well as the range of non-medical and physical effects of cord injury in the acute, subacute, rehabilitation phases as well as in the long term. WEM lectured worldwide in developed and developing countries. He contributed to the literature with over 150 publications. He published his observations on the prognostic indicators of neurological recovery following Traumatic Spinal Cord Injuries and Introduced the concept of “Physiological Instability of the Injured Spinal Cord ” and its influence on clinical management. WEM demonstrated that with simultaneous Active Physiological Conservative Management of all the physiologically impaired and malfunctioning systems of the body together with the injured spine neurological improvement up to complete recovery occurs in the majority of patients irrespective of the degree of Biomechanical Instability, Canal encroachment or Cord Compression. He is Peer reviewer for a number of Journals. WEM held the offices of: President of the International Spinal Cord Society, Chairman of the British Association of Spinal Cord Injury Specialists and Executive Member of the BSRM. Founder Member and trustee of SPIRIT Educational Charity in Spinal Injuries and Transhouse Charity that provides interim accommodation between hospital and home for patients. He raised about six million pounds from charity to rebuild and furnish the MCSI. Advisor to WHO‘s & Co-author of the WHO International Perspectives on Spinal Cord Injury which was published in 2013, Member of the NICE Guideline Developing Group in spinal injuries. He received a number of awards including: the Medal of the International Spinal Cord Society, National Hospital Doctor Team Award for Innovation, Paul Harris Fellowship of the Rotary Club Outstanding achievement award from the Chinese Society of Spinal Injuries, Outstanding Consultant Achievement award by the Spinal Injury Association, Hon. Presidency of the Romanian Spinal Cord Society. He was commended in the House of Lords on two occasions. WEM‘s is an advocate for the demonstration of evidence based clinical management, the right of the patient to make a fully informed choice between the various methods of treatment including that of the injured spine. He strongly advocates for the management of patients by knowledgeable, well trained, experienced Clinicians and a team of Health Care professional in Specialised Spinal Cord Injury Centres with a fit for purpose infrastructure from the early hours or days following injury to enable the team to meet all the medical and non-medical needs of patients with such rare and complex condition