12^th International Conference on
Osteoporosis, Arthritis and Musculoskeletal Disorders

Biography:

Wagih El Masri 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 Injuries acute, subacute, rehabilitation phases as well as in the long term. He is the author of the concept of “Physiological Instability of the Injured Spinal Cord ”and an advocate for the evidence based Active Physiological Conservative Management of the patient. He lectured worldwide in developed and developing countries, contributed to the literature with over 140 publications including the Prognostic Indicators of Neurological Recovery, the long term incidence of Post Traumatic Syringomyelia and the increased incidence of Bladder Cancer in SCI patients. He held the offices of President of the International Spinal Cord Society & Chairman of the British Association of Spinal Cord Injury Specialist

Abstract:

The management of traumatic spinal cord injury (TSCI) has been controversial for the last two centuries. Better visualisation by CT and MRI together with improved instrumentation & increased safety of anaesthetic 35 years ago resulted in a change of practice from Active Physiological Conservative Management (APCM) of the spinal cord injury together with all its medical and non-medical effects to resources being directed to a focused surgical management of the injured spine with fragmentation of management of other effects of cord damage. This was based on the Assumptions that surgical Decompression and Stabilisation will result in better neurological recovery, prevention of neurological deterioration, earlier mobilisation and completion of Rehabilitation, shorter hospitalisation and reduced cost of management. Unfortunately those who advocate Surgical Intervention are basing the same principles of Management to the Neurologically Intact and the Neurologically Impaired patient whose Physiology is impaired, whose Spinal Cord is Patho-Physiologically Unstable and who are at risk of neurological deterioration by Surgery and by Early Mobilisation. Furthermore to date there is no evidence that: Neurological Outcomes, Duration of Rehabilitation, Period of Hospitalisation or Cost of Management are improved by surgical intervention on the spine of patient with cord injury and the opposite is likely to be true. A Spinal Cord Injury (SCI) results in a multi-system impairment and malfunction, paralysis, sensory loss and a potential wide range of medical and non-medical complications. The injured spinal cord is Physiologically Unstable and can be further damaged by non-mechanical complications. Hypoxia, hypertension, hypotension, sepsis, hypothermia, fluid overload can easily occur causing more neurological damage. Patients require scrupulous simultaneous attention of all effects of paralysis to ensure: maximum neurological recovery, prevent complications including long term pain, achievement of maximum range of movement of the spine essential for independence in the wheelchair to minimise cost of support in the community, ensure safe and convenient functioning of all body systems, ensure long term maintenance of health to minimise readmission with complications and enable the patient to actively contribute to the society. The prognostic indicators of neurological recovery based on the initial sensory sparing without intervention will be demonstrated and discussed. The irrelevance of traumatic Biomechanical Instability, Spinal Canal Encroachment and Cord Compression on prognosis of neurological recovery in patients with sensory sparing on presentation will be demonstrated. The possible disadvantages, complications and hazard of Surgical Stabilisation, Surgical Decompression and Early Mobilisation will be discussed . The Outcomes of APCM will be demonstrated. The importance of future research with relevant outcomes to target will be highlighted . The full text can be accessed and shared free of charge from the following website address: http://journals.sagepub.com/eprint/V9qda2SDWRT7fEMYttqF/full