Spinal surgery is considered unnecessary if there is pain, but no radiological abnormalities or neurologic deficits. In a year-long study by a senior neurosurgeon, 47 out of 274 spinal surgeries had been considered unnecessary, but were completed anyway. These patients complained of pain in either the cervical or lumbar areas, but had no other abnormal findings.

Of the unnecessary surgeries, roughly half were lumbar interbody fusions, and other half were cervical fusions in combination with laminectomy or diskectomy. Most of the patients had co-existing disorders that may have been a cause for the pain, or were considered risky for surgery. These disorders included hypertension, severe psychiatric disorder, morbid obesity, high cholesterol, asthma, multiple sclerosis, and fibromyalgia.

Unnecessary spinal surgery is fairly common, expensive, and not in the best interest of patients.

Epstein NE, & Hood DC. “Unnecessary” spinal surgery: A prospective 1-year study of one surgeon’s experience. Surgical Neurology International. (November 2011).

In a large study of more than 72,000 traumatic brain injury patients and more than 200,000 controls, over a period of six years, researchers have recently reported an increased risk of multiple sclerosis after traumatic brain injury.

Multiple sclerosis is a disease of the central nervous system, in which the myelin sheath (white matter) is attacked, resulting in a wide range of neurological problems, including blindness and motor impairments. It has been suggested that one of the potential triggers of multiple sclerosis is a previous brain trauma, but no previous research has been able to support this. The current study suggests that traumatic brain injury, in combination with genetic and other environmental influences, may contribute to the development of multiple sclerosis.

There is a limitation to the study in that it was based in China. Other studies based in other nations have failed to find the same association between traumatic brain injury and multiple sclerosis. It is unknown if these differences are due to genetic profiles (China has a relatively low rate of multiple sclerosis) or other environmental factors.

However, another issue is that reporting measures are not consistent between nations. For instance, other studies may have included only more severe cases of brain injury. Severe cases of traumatic brain injury might “mask” symptoms of multiple sclerosis, and may have therefore led to skewed results. The current study included all cases of traumatic brain injury, and the researchers felt that their results represented an accurate view of multiple sclerosis in China.

Kang J-H, & Lin H-C. Increased risk of multiple sclerosis after traumatic brain injury: A nationwide population-based study. Journal of Neurotrauma. (December 2011).

Laser therapy has been long known to heal wounds, alleviate pain, and reduce inflammation. Low level light therapy (LLLT) is considered to be a “cold” type of laser therapy because it does not emit enough power to produce significant heat—making it safe for use in most people.

More recent research has begun to narrow the science of LLLT into certain wavelengths and sources that provide the greatest benefit to specific diseases.
However, because LLLT must be given at a dosage and source that is very disease-specific to be a benefit, it has been a challenge to produce consistent results. LLLT has therefore remained a somewhat controversial and “alternative” treatment.

A recent review of LLLT has suggested that it should be seriously considered for the treatment of traumatic brain and spinal cord injuries. Animal studies of brain and spinal injury, as well as trials with stroke patients have already shown some benefits from LLLT. Very few effective therapies currently exist for brain and spinal injury, and LLLT has the potential to provide a safe method of reducing inflammation and pain.

Chung H, Dai T, Sharma SK, et al. The nuts and bolts of low-level laser (light) therapy. Annals of Biomedical Engineering. (November 2011).

Neonatal encephalopathy, or disturbed neurological functioning in a term infant, affects between 1 and 7 babies out of 1000 live births. It causes permanent disability in terms of cognitive and motor development in 15-20% of affected newborns. An MRI scan can help predict outcomes for infants with brain injury, with increasing levels of accuracy.

A recent study found that:

• The presence of brainstem lesions is predictive of mortality. Close to half of infants with these lesions die within the first three years of life.
• Mesencephalic and pontine lesions, alone or in combination, are also associated with high rates of mortality.
• The severity of damage to basal ganglia and thalamus (BGT) is predictive of motor impairment, with 89% accuracy.
• BGT is closely associated with cerebral palsy (CP)—the worse the BGT injury, the higher the risk of CP. Infants with severe BGT injuries have near universal rates of CP.
• Damage to the white matter, cortex, and brainstem is not associated with motor impairment.

Further study of these associations shows promise in improving outcomes.

Inder, TE. Predicting outcomes after perinatal brain injury. Nature. (October 2011).

In the highly supportive environment of early childhood, children with traumatic brain injury do not show evidence of significant friendship problems. However, as children age, relationships become more complex, and children with TBI become more vulnerable to social isolation and poor peer interactions.

Children with traumatic brain injury often show cognitive deficits related to emotional recognition and social problem solving. This can have negative impact on social functioning. A recent study on children ages 7-14 found that, while 75% of the control group reported 4 or more friends, only 39% with mild, 20% with moderate, and 14% of children with severe TBI had the same number. Researchers also found that children with severe TBI had difficulty managing conflict and less intimacy in their friendships.

Children with TBI have more severe problems with hyperactivity, attention deficit disorders, and emotional problems, which impact their ability to communicate and participate socially. Children with TBI may also be likely to experience loneliness and poor quality of life as a result of their injuries.

Ross, KA, McMillan, T, Kelly, T, Sumpter, R, and Dorris, L. Friendship, loneliness, and psychosocial functioning in children with traumatic brain injury. Brain Injury. (November 2011).

People with traumatic brain injury often have complex problems that require multifaceted solutions. Networks, which consist of individuals, teams, and organizations that are linked together, are frequently touted as a method for addressing the difficulties these patients face in accessing resources. Networks do show promise in improving continuity of care, but some specific issues should be addressed before there is widespread implementation. To be effective, networks need to be adaptable and to have capacity.

First, expectations need to be in line with the size and scope of the network. A small committee that meets sporadically cannot handle the same tasks as a comprehensive group that meets regularly. Second, you get what you pay for. While networks may be a cost-effective way of improving services, they require economic and human resources to function. Lack of investment in design, implementation, and maintenance can be a significant problem.

Third, networks need support from stakeholders. Without buy-in from all involved, networks lack legitimacy. Finally, there must be genuine collaboration. A common language and vision must be established and maintained in order for a traumatic brain injury network to be effective.

Lamontagne, ME, Swaine, BR, Lavoie, A, and Careau, E. Analysis of the strengths, weaknesses, opportunities and threats of the network form of organization of traumatic brain injury service and delivery systems. Brain Injury. (November 2011).

Functional MRI (fMRI) is a type of neuroimaging that can display brain activity that corresponds to different tasks. One potential use for fMRI is to assess brain functioning in people who are in a minimally conscious state due to severe traumatic brain injury.

In a case study, a severely brain-injured young woman who was in a minimally conscious state was given imagery tasks while being measured by fMRI. One task was to imagine playing tennis, and the other was to imagine walking through her house. The fMRI results of the injured patient were compared to 8 healthy controls.

The results were that the tennis task produced the same fMRI response in the patient as the healthy controls. The walking through the house task did not produce the same result, but the patient had sustained an injury to the part of the brain specific to the spatial imagery needed to perform the task.

Using fMRI can therefore be effective for assessing brain functioning—not only to determine consciousness, but also to help determine the location and extent of lesions.

Aslaksen M & Vangberg TR. Probing for consciousness after severe brain injury by functional magnetic resolution (fMRI). Journal of Neurology. (September 2011).

The corpus callosum, the white matter tracts that connect one side of the brain to the other, changes size and shape during childhood development and well into early adulthood. The thinning of the corpus callosum, particularly the posterior area, has been thought be a normal part of development.

However, a recent study has shown that childhood brain injury has a strong association with the thinning of the posterior area of the corpus callosum. The study looked at brain scans of people who suffered a childhood brain injury (ten years past) and compared them to scans of people who never had a brain injury. They found that 63% of people who had a childhood brain injury had significant thinning to the corpus callosum, versus only 30% of non-brain injured people.

The research that supported the developmental theory of the thinning corpus callosum did not take clinical history into account. This most recent study provides evidence that a thinning corpus callosum might not be a normal occurrence, but a marker of past brain injury.

Beauchamp MH, Ditchfield M, Catroppa C, et al. Focal thinning of the posterior corpus callosum: Normal variant or post-traumatic? Brain Injury. (September 2011).

Discharge Against Medical Advice (DAMA) is associated with poor outcome, frequent readmission, higher mortality, and increased risk of psychiatric and medical complications. Research has shown that head injury is highly correlated with DAMA.

A recent review of past research has looked more specifically at the relationship with DAMA and traumatic brain injury. Researchers found that DAMA was more frequent in cases of intentional traumatic brain injury. Intentional brain injuries can occur because of a suicide attempt, as well as antisocial, aggressive and disruptive behaviors. DAMA was also associated with younger age (25-34) and drug or alcohol abuse.

Knowing the characteristics of patients at high risk for DAMA can help hospital staff implement prevention policies, limit DAMA occurrence, and help protect vulnerable patients from a potentially negative outcome.

Kim H, Colantonio A, Bayley M, & Dawson D. Discharge Against Medical Advice after traumatic brain injury: Is intentional injury a predictor? The Journal of Trauma Injury, Infection, and Critical Care. (September 2011).

Traumatic brain injury, head injury, and concussion are all terms that can be used interchangeably when describing the now accepted clinical diagnosis “mild traumatic brain injury.” The clinical definition of mild traumatic brain injury has only recently been accepted, and clinicians and researchers still seem to struggle with the term. Understandably, the public is now very confused.

Researchers who polled random people from the community found that the public incorrectly evaluated 20% of basic statements made about traumatic brain injury. In addition, when different terminology was used, the public attributed more a negative association to “brain injury” than to “head injury.” Half of the participants who had experienced a concussion did not acknowledge to having had a brain or head injury.

One reason for this confusion is inconsistent information from the Internet. When a person experiences a concussion (mild traumatic brain injury), a decision has to be made whether or not to pursue medical attention. Confusion, inaccurate knowledge, and inconsistent information can mean that many people who require medical attention could be slipping through the cracks.

McKinlay A, Bishop A, & McLellan T. Public knowledge of “concussion” and the different terminology used to communicate about mild traumatic brain injury (MTBI). Brain Injury. (July 2011).