|Year : 2013 | Volume
| Issue : 1 | Page : 71-72
Relevance of recording and studying spinal cord injury in patients with electric burns of head and neck
Consultant Plastic Surgeon, Jai Clinics, Nagpur, India
|Date of Web Publication||22-Nov-2013|
Jai Clinics, 3rd Floor, Shrika Corporate, 35, Pandey Layout, Khamla - 440 025, Nagpur, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kothe S. Relevance of recording and studying spinal cord injury in patients with electric burns of head and neck. Indian J Burns 2013;21:71-2
|How to cite this URL:|
Kothe S. Relevance of recording and studying spinal cord injury in patients with electric burns of head and neck. Indian J Burns [serial online] 2013 [cited 2019 Dec 7];21:71-2. Available from: http://www.ijburns.com/text.asp?2013/21/1/71/121888
Electric injuries come up, time and again, in the practice of a Plastic Surgeon. In many instances, these patients are referred to Plastic Surgeons to tackle acute necrosis of tissues, to debride, and reconstruct as necessary. Areas of necrosis deep into the tissues keep evading diagnosis and complicate timely treatment, and may require amputations, minor or major. Deformities arising out of high voltage electric burns are many times long-lasting or permanent, and may require the highest level of involvement on the part of the Plastic Surgeon. These sequelae/complications may hamper usage of parts, and may mar useful reemployment of the patients.
This paper highlights some of the important aspects of electric injuries. There is scant literature available on the involvement of head and neck in electric injuries, and this paper is important from that perspective. Authors have highlighted issues pertaining to involvement of head and neck, and enumerated sequelae/complications. Authors have also mentioned surgical procedures, although without going into details.
One of the consequences of head and neck electric injury is spinal cord damage. Authors have mentioned in the complications about this, but not gone into details. A total complication rate of about 21% is probably healthy, looking at the type of injury (this paper), but other papers mention about 8% incidence of spinal cord sequelae itself.  Detailed information about the spinal cord consequences will be of immense use. Such sequelae will define the post-injury recovery of these people towards making a living again.
The diagnosis of neurological deficit following spinal cord injury due to electric burn can be difficult, and may be significantly delayed. Establishing a diagnosis is not an easy task, as examination for neurodeficit may itself be delayed because of the patient's general condition. Delay could also occur due to intense focus towards the treatment of life-threatening or limb/body-part threatening injuries due to electric burn.
Although delayed spinal cord injury following high-voltage electrical burn is not a life-threatening sequelae, complete recovery is not the rule and the morbidity is high.  There is a linear relationship between head and neck electric burn and spinal cord injury. Hence, a focus on these neurosequelae is important when one wants to focus on long-term recovery and rehabilitation. Spinal cord injuries may also hamper job related capabilities, and could mean unemployment or demotion.
A previous paper mentions that at the time of diagnosing spinal cord damage in patients with electric burn, CT scans or MRIs were normal or unhelpful.  Electromyogram (EMG) and Nerve Conduction studies may also not lead to an inference. , This may further make the picture hazy, and interfere with timely or early treatment of the spinal cord injury. Clinical examination, and a very high level of suspicion is probably the key to picking up diagnosis of spinal cord damage in electric burn patients. Diagnosis of spinal cord injury has been made as early as 2 days,  to as late as a couple of weeks after the burn.  The postulated pathophysiology is due to the anatomical characteristics of the arterial blood supply of the spinal cord. 
Treatment has mainly been supportive, with steroids, prostaglandins as drugs, long durations of physiotherapy, and orthoses. ,
Recovery from spinal cord damage could be complete or only partial.  Long-term therapies and permanent partial recovery will come in the way of reemployment of the patients.
Hence, I would like to bring into focus the importance of recording and scientifically enquiring about spinal cord injury following electric burns of the head and neck area. Any paper which researches consequences of electric burns of the head and neck should elaborate on spinal cord injury and its sequelae.
| References|| |
|1.||Arevalo JM, Lorente JA, Balseiro-Gomez J. Spinal cord injury after electrical trauma treated in a burn unit. Burns 1999;25:449-52. |
|2.||Ko SH, Chun W, Kim HC. Delayed spinal cord injury following electric burns: A 7-year experience. Burns 2004;30:691-5. |
|3.||Erkin G, Akinbingol M, Uysal H, Keles I, Aybay C, Ozel S. Delayed cervical spinal cord injury after high voltage electric injury: A case report. J Burn Care Res 2007;28:905-8. |
|4.||Ratnayake B, Emmanuel ER, Walker CC. Neurological sequelae following a high voltage electric burn. Burns 1996;22:574-7. |
|5.||Koller J, Orsagh J. Delayed neurological sequelae of high-tension electric burns. Burns 1989;15:175-8. |