Spinal cord最新文献

Study design: Cross-sectional survey.

Objectives: To identify the factors determining the employment of individuals with spinal cord injury (SCI) living in South Korea, which shows a lower-than-average employment rate in international comparative studies, and to examine the potential importance for policy.

Setting: Community of patients with SCI who are members of the Korea Spinal Cord Injury Association (KSCIA).

Methods: A survey involving 200 members of the KSCIA was conducted. In the analysis, we included 177 individuals aged 15-64 years and were at least 2 years post-injury at the time of the survey. Descriptive statistics were calculated and logistic regression was applied to examine the association between 11 variables and employment outcomes.

Results: A higher "education level" and participation in "vocational rehabilitation services" were positively associated with employment for individuals with SCI. By contrast, "receiving welfare benefits" was negatively associated with employment probability. The analysis, which categorized employment predictors into human capital, injury, and environmental models, showed no associations for factors in the Injury Model but indicated positive associations for education in the Human Capital Model and for receiving compensation in the form of welfare benefits and participation in vocational rehabilitation services in the Environment Model.

Conclusions: Among the three models, the Environment Model had the greatest explanatory power. This suggests that in Korea, policy interventions targeting modifiable environmental factors hold significant potential to improve employment outcomes for individuals with SCI.

Study design: Survey.

Objectives: Intraoperative ultrasound (IOUS) is an emerging tool for assessing the injured spinal cord during surgical intervention and particularly after traumatic spinal cord injury (SCI). The extent of utilization of this technique is unknown. To assess whether a knowledge gap exists regarding IOUS in managing SCI patients, an international survey of spine surgeons was performed.

Setting: International Survey.

Methods: Members of the AO Spine international community were surveyed using a web-based questionnaire developed by an SCI expert commission. The categorical data were analyzed descriptively.

Results: Of the 276 completed surveys, 22% (n = 61/276) indicated IOUS was utilized during spine surgery, with most responses coming from Europe (38% n = 24/61) and North America (30% n = 18/61). Only 41% (n = 25/61) had received formal IOUS training. There were 59% (n = 36/61) of respondents who indicated they use IOUS on patients with acute SCI, mainly to assess adequate decompression. Of those not using IOUS, 50% (n = 107/215) did not have access to an ultrasound machine available. Overall, 92% (n = 254/276) indicated that an IOUS training course would be beneficial to improve understanding and patient care.

Conclusions: This international survey of spine surgeons demonstrated that currently, there is limited use of IOUS in the surgical management of acute SCI. Understanding the needs of spine surgeons and tailoring educational opportunities may increase the role of IOUS. Given the importance of surgical decompression in enhancing outcomes after acute SCI coupled with the ability of IOUS to assess decompression, greater adoption of IOUS could further enhance the efficacy of decompressive surgery.

Study design: Retrospective cross-sectional survey of Korean patients with spinal cord injury (SCI) within 6 months post-injury.

Objectives: To evaluate urodynamic parameters and identify unfavorable urodynamic findings in patients with neurogenic bladder due to SCI during the acute to subacute stages of the disease based on the post-injury time interval.

Setting: National Rehabilitation Center, Seoul, Korea.

Methods: Data from urodynamic tests performed on individuals with SCI within 6 months post-injury were collected. Based on the time interval from injury to testing, the recruited patients were divided into three groups: 0-90 days, 91-135 days, and 136-180 days. Based on these groups, urodynamic test parameters and incidence of high-risk findings (high detrusor pressure exceeding 40 cmH₂O during the filling phase, low compliance of the bladder, and detrusor-sphincter dyssynergia [DSD]) and unfavorable urodynamic findings (detrusor overactivity [DO], underactive or acontractile bladder) were compared.

Results: Analysis of urodynamic study (UDS) findings in 191 individuals with acute to subacute SCI, revealed that unfavorable urodynamic findings were observed within 3 months after injury in both complete and incomplete SCI. The UDS test results and incidence of unfavorable outcomes based on the interval between injury and examination showed no significant statistical differences over time.

Conclusions: The urodynamics of individuals with SCI suggest that high-risk or unfavorable urodynamic results are common in the acute to subacute stages of SCI.

Study design: Single-institution retrospective study.

Objectives: To assess postoperative functional and quality of life (QOL) outcomes in elderly patients who underwent cervical spinal cord tumor surgery using the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ).

Setting: Single university hospital.

Methods: This retrospective study included 97 patients who underwent surgery for cervical spinal cord tumors between 2000 and 2016. Patients were divided into two groups: a younger group (patients < 65 years old) and an elderly group (patients ≥ 65 years old). Surgical outcomes were evaluated using JOA scores and JOACMEQ, with statistical comparisons between age (younger vs. elderly) and tumor types (intramedullary vs. extramedullary).

Results: Preoperative JOA scores were significantly lower in the elderly group compared to the younger group. Postoperative recovery rates were similar between the two groups. Extramedullary tumor resections in the elderly showed notable functional improvements. Conversely, elderly patients with intramedullary tumors exhibited poorer outcomes in lower extremity function and QOL, as measured by the JOACMEQ.

Conclusion: Surgical intervention for cervical spinal cord tumors in elderly patients can yield functional and QOL outcomes similar to those in younger patients, especially for extramedullary tumors. However, intramedullary tumor resections in the elderly may result in less favorable outcomes, particularly in lower limb function and QOL. These findings underscore the importance of thorough preoperative counseling for elderly patients, highlighting potential risks and benefits based on tumor type.

Study design: Animal study.

Objectives: To investigate the influence of lumbar arteries ligation on spinal cord blood flow (SCBF), and to determine by what proportion the SCBF decrease would cause spinal cord ischemia (SCI) in rabbit model.

Setting: Sir Run Run Shaw Hospital, Zhejiang University School of Medicine.

Methods: SCI model was established by ligation of lumbar arteries in rabbits. 20 rabbits were divided into four groups: group A, sham surgery without ligation; group B, ligation at 3 levels; group C, ligation at 4 levels; group D, ligation at 5 levels. The SCBF was measured with laser doppler flowmetry, motor function was assessed using modified Tarlov grading system, and neurophysiological integrity was detected with motor-evoked potential (MEP), followed by histological observation on the seventh day after operation.

Results: Lumbar arteries ligation at 3 levels led to average 40% decrease of SCBF, and spinal cord remained functional, electrophysiological and histological normal. Lumbar arteries ligation at 4 levels resulted in average 50% decrease of SCBF, slight motor dysfunction, prolonged latency of MEP and decreased cell volume of neuron, rabbits presented mild spinal cord injury. Lumbar arteries ligation at 5 levels caused average 60% decrease of SCBF, complete paraplegia, loss of MEP waveform and neuron karyopyknosis, rabbits presented severe SCI.

Conclusion: More ligation of bilateral lumbar arteries leads to lower SCBF and increase the risk of SCI in rabbits, SCBF decreased by more than 50% could cause SCI. MEP associated significantly with SCBF, suggesting the usefulness of MEP to monitoring SCBF in surgery.

Study design: Clinical prospective study.

Objectives: To histologically examine puncture biopsies of early neurogenic heterotopic ossification (NHO) in spinal cord injured individuals.

Setting: University of Bochum, Germany.

Methods: After acute spinal trauma, participants underwent a sonographic examination of the hip joints and a routine laboratory examination. Magnetic resonance imaging (MRI) or computed tomography (CT) of the pelvis was performed if there were clinical and laboratory signs of NHO and sonographic evidence of edema and/or calcifications in the tissue around the hip joint. If NHO were detected, tissue was obtained and preserved for histological examination from the involved tissue around the hip joint affected by NHO and from an unaffected calf as control. Nine participants with a complete spinal cord lesion American Spinal Injury Association Impairment Scale (AIS) grade A and evidence of an acute NHO in the hip joint muscles were recruited for the study.

Results: In all sonographic examinations of the hip joint, edematous changes could be detected. In one case, calcifications were detected sonographically. In MRI/CT in six participants, ossification could already be detected. All histological specimens from the NHO-affected gluteal region showed varying degrees of tissue deformation. The unaffected reference samples showed regular muscular structure microscopically.

Conclusions: It was possible to show and compare histological changes in NHO-affected tissue with MRI/CT imaging, depending on the stage of NHO.

Trial registration: DRKS, DRKS00034049. Registered 12 April 2024 - Retrospectively registered, https://www.drks.de/DRKS00034049 .

Study design: A cross-sectional validation study.

Objectives: The aim of the study was to create a Turkish version of the Spinal Cord Independence Measure Self-Report (SCIM-SR) scale and verify its validity and reliability.

Setting: Rehabilitation Department at Istanbul Physical Medicine and Rehabilitation and Training Research Hospital.

Methods: The Turkish version of SCIM-SR was translated from English using forward and backward translation in accordance with standard guidelines and 90 participants completed the SCIM-SR Turkish form. At the same time, a Spinal Cord Independence Measure III (SCIM III) was administered to the participants by a health professional through observation. Cronbach's alpha, Pearson and Spearman correlation coefficients were used to evaluate the internal consistency and concurrent validity.

Results: The Cronbach's α coefficients for the total scale was 0.883. For the subscales, it was 0.929 for self-care, 0.571 for respiration and sphincter management and 0.885 for mobility. Test-retest reliability after two weeks yielded Spearman coefficients above 0.92 for the total scale and all subscales. When analyzing the correlation between SCIM-SR and SCIM III, the intraclass correlation average and its lower and upper bound values were as follows: 0.984 (0.976-0.990) for self-care; 0.970 (0.955-0.980) for respiration and sphincter management; 0.968 (0.951-0.979) for mobility and 0.980 (0.969-0.987) for the total. There was good agreement between SCIM-SR and SCIM III when evaluating the total score in Bland-Altman graphs. The Bland-Altman analysis revealed no significant proportional bias (0.76; 95% CI [-21.34, 22.87]), but a significant fixed bias was observed.

Conclusions: The Turkish version of SCIM-SR demonstrated excellent internal consistency and good validity in Turkish individuals with spinal cord injury.