Does anyone know if spinal cord injury is common due to blasts? I have a nice spinal cord model and thought it might be useful for that...
In my clinical experience of 25 years as a orthopaedic trauma surgeon I have not seen any SCI related to blast in civilian population in Lothian, SE Scotland. However may be more commonly seen by military surgeons.
Interesting question, my initial thought is why wouldn't there be SCI due to blast? In unprotected sever blast the over-pressure wave disrupts surface interface density changes (i.e. air to fluid e.g. lungs) causing barotrauma injury. Vertebra to CSF to spinal cord could produce some cavitation resulting in injury. Additionally, long fibers may have the propensity to absorb more of the over-pressure energy, potentially causing a "diffuse axonal injury"-like etiology. However, in unprotected blast I would hypothesize that the level necessary to cause SCI would also be lethal barotrauma to the lungs and/or gut. I agree with Mustafa Ali Khan, predictive value and imaging correlates would be the ideal. There are several obstacles: blast wave replication in the laboratory (blast model), isolation of injury to SCI only, obtaining replicable data (blast over-pressure Friedlander waveform) etc. Complex challenges all but not impossible with attention to detail. Good luck.
These are some fantastic ideas! Thank you all so much. My lab has a high resolution 3D model of the spinal cord including all dorsal and ventral nerve rootlets (I would say it is the most detailed in the world). We were thinking it might be interesting model SCI due to blast injury. Sounds like it might not be that interesting...and it not likely a clinical problem. Correct? If you are interested, I could send one of you a model to think about working with (collaboration). Thanks again to all!
A high resolution 3D model of spinal cord and nerve roots might clarify two mechanisms which underlie blast induced SCIs.
They might even contribute to a better understanding of parallel findings of an unexplained nature.
(1) The direct injuring of the cord surface and nerve roots produced by repeated CSF injections (Bunge MB, Bunge RP, Ris H. J Biophys Biochem Cytol 1961; 10:67-94) and
(2) The remote or widespread spinal cord damages seen and illustrated after experimental impacts (Schmaus H. Arch Path Anat Physiol Klin Med 1890; 122:326-, added plate) or a grenade explosion affecting the lower spine (Mussen A. Rev Neurol Psychiat 1916; xiv:417-, plates 7,8) relating to the cord insertion of mainly the denticulate ligament.
They appear of interest for a better understanding of spontaneously arising lesions affecting the spinal cord along its mooring points and lines (Oppenheimer DR. Neuropath Appl Neurobiol 1978; 4:151-620
Conference Paper Modeling Primary Blast Injury in Isolated Spinal Cord White Matter
I haven’t seen any in my neurosurgical practice however, as someone said above, it is known to military doctors. I have attached a link above FYI.
Many paraparetic or paraplegic World War soldiers who lacked evidence of paraspinal soft tissue injury or vertebral injury were initially considered to be either hysterical or malingering, until postmortem histological study of their spinal cords disclosed pathology which fit their clinical pictures, thereby leading to widespread acceptance that "passing by" bullets can produce shock waves which severely injure the spinal cord. I suspect that you would probably would enjoy pursuing historical military literature on spinal cord injury.
Indeed, Eugene Kuchner. A comprehensive analysis of the accounts on a scattering of spinal cord/nerve root lesions in the course of local impacts or blasts involving part of the spine is worth the effort.
German pathologists referred to them as "Fernherde" - impact remote lesions, spread within the spinal canal.
The 1916 Mussen paper I quoted above is one of the (unfortunately utterly rare exceptions) in which some part of the observed damage was depicted.
This is really detailed information and great ideas! Thanks a lot for your input.
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