Spinal cord最新文献_第3页

Spinal cord vascular autoregulation: key concepts and opportunities to improve management 脊髓血管自动调节：关键概念和改善管理的机会。

IF 2.2 4区医学 Q3 CLINICAL NEUROLOGY

Spinal cord

Pub Date : 2025-12-09 DOI: 10.1038/s41393-025-01126-5

Denis Routkevitch, Kelly Jiang, Carly Weber-Levine, A. Daniel Davidar, Nitish V. Thakor, C. David Mintz, Kathryn Rosenblatt, Romergryko G. Geocadin, Nicholas Theodore

Narrative review. Vascular autoregulation in the central nervous system (CNS) maintains appropriate perfusion in the context of changing blood pressure. Impaired autoregulation in various diseases often contributes to their pathophysiology. While this mechanism is well characterized in the brain, it remains understudied in the spinal cord, limiting evidence-based blood pressure management in spinal cord pathology. In this review, we summarize the current understanding of spinal cord autoregulation, highlight advancements in cerebral autoregulation, and offer a framework for its clinical application in spinal cord care. A literature search was conducted comparing preclinical evidence of spinal cord autoregulation with current clinical practices in the brain. Although autoregulation has been recognized in the spinal cord, it has been mostly measured in animals, and its clinical impact has been limited. In contrast, cerebral autoregulation has influenced patient care through continuous monitoring of dynamic autoregulation and clinical trials using personalized blood pressure targets. These innovations require measurement of blood flow or a surrogate, which is performed infrequently in the cord. Furthermore, confounding variables, such as arterial CO2 levels, temperature, and pharmacology, must be tightly controlled, as they can affect blood flow and thus interfere with autoregulation measurements. Spinal cord autoregulation is an essential variable in neurology and neurosurgery. A better understanding of this process could improve outcomes in various conditions, including traumatic injury, ischemic injury, and other spinal diseases. As spinal cord blood flow measurement technologies improve, there is a growing opportunity to apply autoregulation to direct patient care.

研究设计：叙述性回顾。目的：在血压变化的情况下，中枢神经系统（CNS）的血管自动调节维持适当的灌注。在各种疾病中，自身调节功能受损往往与疾病的病理生理有关。虽然这种机制在大脑中有很好的特征，但在脊髓中的研究仍然不足，这限制了脊髓病理学中基于证据的血压管理。本文综述了目前对脊髓自动调节的认识，重点介绍了脑自动调节的进展，并为其在脊髓护理中的临床应用提供了一个框架。方法：通过文献检索，将脊髓自动调节的临床前证据与当前大脑的临床实践进行比较。结果：虽然在脊髓中已经认识到自我调节，但它主要是在动物身上测量的，其临床影响有限。相比之下，通过持续监测动态自我调节和使用个性化血压目标的临床试验，大脑自我调节影响了患者的护理。这些创新需要测量血流量或代孕，这在脐带中很少进行。此外，必须严格控制混杂变量，如动脉二氧化碳水平、温度和药理学，因为它们会影响血流，从而干扰自动调节测量。结论：脊髓自身调节是神经病学和神经外科的一个重要变量。更好地了解这一过程可以改善各种情况的预后，包括创伤性损伤、缺血性损伤和其他脊柱疾病。随着脊髓血流测量技术的改进，将自动调节应用于直接患者护理的机会越来越大。

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引用次数: 0

The application of artificial intelligence in the acute and sub-acute phases of spinal cord injury- a systematic review 人工智能在脊髓损伤急性和亚急性期的应用综述。

IF 2.2 4区医学 Q3 CLINICAL NEUROLOGY

Spinal cord

Pub Date : 2025-12-04 DOI: 10.1038/s41393-025-01155-0

Teleale F. Gebeyehu, Mohammad Amin Sabbaghalvani, Giovanna Failla, Ashmal S. Kabani, Yashvi Shah, Alexander Kharichev, Joshua A. Dian, Stavros Matsoukas, Alexander R. Vaccaro, Gregory D. Schroeder, Srinivas K. Prasad, Jack Jallo, Joshua E. Heller, Michael G. Fehlings, James S. Harrop

Systematic Review. To describe applications of AI for traumatic SCI management with focus on diagnostics, prognostication, and therapeutic interventions. PubMed, Scopus and Cochrane libraries were searched (March 2025). Studies published in English between January 1st, 2020, and March 18, 2025, dealing with clinical aspects in the acute, post-injury rehabilitative and first year phases of SCI were included. Studies on brain computer interface, robotics and non-neurologic aspects of SCI were excluded. Extracted were country of study, study design, focus of study, total participants, American Spinal Injury Association (ASIA) Impairment Scale (AIS), machine learning (ML) models, inputs, outcomes and performance metrices. A total of 23 studies with 120,931 individuals were identified. Classical Machine Learning Models, Ensemble Learning Models and Deep Learning Models were the most used ML families. Age, AIS, neurologic level of injury, sex, mechanism of injury and motor score were the most common inputs. Predictions of neurologic status, functionality status, Hospital/ICU utilizations, complications, survival, discharge destination and results of image segmentation and patient grouping were the outputs of interest. The performance metrices were satisfactory in most and higher than humans in some studies. AI can facilitate personalized approach to diagnosis of SCI, prediction of outcomes like neurological improvement, complications, functionality indicators like walking, selfcare and independence, re-admissions, prolonged length of stays, discharge destination and mortality after injury. It was also useful to suggest specific MAP goals and time of surgical intervention. These functions complement clinical judgement.

研究设计：系统评价。目的：描述人工智能在创伤性脊髓损伤治疗中的应用，重点是诊断、预测和治疗干预。方法：检索PubMed、Scopus和Cochrane图书馆（2025年3月）。纳入了2020年1月1日至2025年3月18日期间发表的英文研究，涉及SCI急性期、损伤后康复期和第一年阶段的临床方面。排除了脑机接口、机器人和非神经学方面的研究。提取的数据包括研究国家、研究设计、研究重点、总参与者、美国脊髓损伤协会（ASIA）损伤量表（AIS）、机器学习（ML）模型、输入、结果和性能指标。结果：共有23项研究，涉及120,931名个体。经典机器学习模型、集成学习模型和深度学习模型是最常用的机器学习系列。年龄、AIS、损伤程度、性别、损伤机制和运动评分是最常见的输入。神经系统状态、功能状态、医院/ICU使用率、并发症、生存、出院目的地以及图像分割和患者分组结果的预测是感兴趣的输出。在大多数研究中，它们的性能指标令人满意，在一些研究中甚至高于人类。结论：人工智能可以促进脊髓损伤的个性化诊断，预测神经系统改善、并发症、行走、自理、独立等功能指标、再入院、延长住院时间、出院目的地和伤后死亡率。建议具体的MAP目标和手术干预时间也很有用。这些功能是对临床判断的补充。

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引用次数: 0

Comment on ‘Increased risk of osteoarthritis in persons with spinal cord injury: a population-based longitudinal follow-up study in Taiwan’ 对“台湾脊髓损伤患者骨关节炎风险增加：一项基于人群的纵向随访研究”的评论。

IF 2.2 4区医学 Q3 CLINICAL NEUROLOGY

Spinal cord

Pub Date : 2025-12-03 DOI: 10.1038/s41393-025-01151-4

Weichu Sun, Yuqing Wang, Hui Xiao, Jiachen Liu

引用次数: 0

Improving TNASCI: addressing classification accuracy, autonomic function, and psychological well-being in SCI. 改进TNASCI：解决SCI的分类准确性、自主神经功能和心理健康问题。

IF 2.2 4区医学 Q3 CLINICAL NEUROLOGY

Spinal cord

Pub Date : 2025-12-03 DOI: 10.1038/s41393-025-01153-2

Mingxuan Liu, Hanjun Ma, Ju Liao, Qunqiang Luo

引用次数: 0

Deep tissue injury in patients with spinal cord injury: a magnetic resonance imaging-based risk assessment study. 脊髓损伤患者的深部组织损伤：基于磁共振成像的风险评估研究。

IF 2.2 4区医学 Q3 CLINICAL NEUROLOGY

Spinal cord

Pub Date : 2025-12-01 DOI: 10.1038/s41393-025-01150-5

Yasuhiro Sakata, Takanori Namba, Yasunori Umemoto, Tatsuya Yoshikawa, Kazunari Furusawa, Gen Yamada, Shinichi Asamura

Study design: Cross-sectional observational study.

Objectives: Deep-tissue injury (DTI) originates in subcutaneous soft tissue and progresses outward without early skin changes, making diagnosis difficult in people with spinal-cord injury (SCI). We evaluated the incidence of DTI with magnetic resonance imaging (MRI) and sought associated risk factors.

Setting: Kibikogen Rehabilitation Center for Employment Injuries, Japan.

Methods: Fifty-six wheelchair-dependent adults with SCI of at least 1 month's duration underwent pelvic sagittal STIR MRI screening. DTI-positive sites were defined by signal changes in subcutaneous fat or muscle. Ultrasonography, body composition, seating-related variables, and laboratory data were collected concurrently. Univariate and multivariate logistic-regression analyses identified independent risk factors.

Results: MRI detected subclinical DTI in 33 of 112 ischial regions (29.5%). Ultrasonography was concordant in only 15 sites (45.5%). Multivariable analysis showed that longer daily wheelchair use (p = 0.018), greater subcutaneous-tissue thickness at the ischial tuberosities (p = 0.028), and less-frequent pressure-relief manoeuvres (p = 0.031; protective) were independently associated with DTI. BMI, peak interface pressure, and routine haematologic or nutritional markers were not significant.

Conclusions: MRI screening revealed subclinical DTI in nearly one-third of wheelchair-dependent patients with SCI and outperformed ultrasonography for early detection. Extended sitting time, thicker subcutaneous fat at the ischial tuberosity, and infrequent pressure relief emerged as modifiable risk factors. A risk-based MRI surveillance strategy may enable timely preventive interventions and reduce progression to overt pressure ulcers.

研究设计：横断面观察性研究。目的：深组织损伤（Deep-tissue injury， DTI）起源于皮下软组织，向外发展，无早期皮肤变化，使脊髓损伤（spinal-cord injury， SCI）患者的诊断困难。我们用磁共振成像（MRI）评估DTI的发病率，并寻找相关的危险因素。地点：日本Kibikogen工伤康复中心。方法：56例患有脊髓损伤至少1个月的依赖轮椅的成年人接受骨盆矢状面STIR MRI筛查。dti阳性部位通过皮下脂肪或肌肉的信号变化来确定。同时收集超声检查、身体成分、坐姿相关变量和实验室数据。单因素和多因素logistic回归分析确定了独立的危险因素。结果：112个坐骨区MRI检出亚临床DTI 33个（29.5%）。超声检查仅有15处（45.5%）吻合。多变量分析显示，每天使用轮椅的时间较长（p = 0.018），坐骨结节皮下组织厚度较大（p = 0.028），以及减压操作频率较低（p = 0.031；保护性）与DTI独立相关。BMI、峰值界面压和常规血液学或营养指标无显著性差异。结论：MRI筛查显示近三分之一的脊髓损伤轮椅依赖患者存在亚临床DTI，在早期发现方面优于超声检查。坐位时间延长，坐骨结节处皮下脂肪增厚，以及不频繁的减压成为可改变的危险因素。基于风险的MRI监测策略可以实现及时的预防性干预并减少进展为明显的压疮。

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引用次数: 0

Determinants of functional recovery and length of stay in spinal cord injury inpatients: a retrospective analysis. 脊髓损伤住院患者功能恢复和住院时间长短的决定因素：回顾性分析。

IF 2.2 4区医学 Q3 CLINICAL NEUROLOGY

Spinal cord

Pub Date : 2025-11-27 DOI: 10.1038/s41393-025-01154-1

Fatma Kumbara, Zuhal Ozisler, Elif Yalçın

Study design: Retrospective cohort study.

Objectives: To identify clinical and demographic factors associated with functional recovery and length of hospital stay in individuals with spinal cord injury undergoing inpatient rehabilitation.

Setting: Physical Medicine and Rehabilitation Center at Ankara Bilkent City Hospital, Turkey.

Methods: Medical records of patients with spinal cord injury admitted for inpatient rehabilitation between January 2020 and September 2023 were retrospectively reviewed. Demographic characteristics, injury-related variables, neurological level, ASIA classification, SCIM III scores, complications, assistive rehabilitation interventions, bladder management, and functional status were collected. Univariate analyses (Mann-Whitney U, Kruskal-Wallis, Chi-square) were performed, followed by multivariate regression to identify independent predictors of functional outcomes.

Results: A total of 342 patients were included (mean age 38.9 ± 16.2 years). The mean length of stay was 41.6 ± 20.3 days. Univariate analyses showed that age, time since injury, neurological level, multiple hospitalizations, SCIM III scores, complications, advanced rehabilitation technologies, and bladder catheterization were significantly associated with both functional status and hospitalization duration (p < 0.05). Multivariate regression demonstrated that age (β = -0.24, 95% CI: -0.35 to -0.13, p < 0.001), presence of complications (β = -0.31, 95% CI: -0.46 to -0.17, p < 0.001), and bladder catheterization (β = -0.19, 95% CI: -0.32 to -0.07, p = 0.004) were independent predictors of discharge SCIM III scores.

Conclusions: Age, neurological integrity, complications, and bladder management are key determinants of functional outcomes in SCI rehabilitation, while these factors also influence length of stay. Early complication prevention, optimized bladder care, and tailored rehabilitation strategies may enhance recovery and shorten hospitalization.

Sponsorship: No commercial sponsorship was received for this study.

研究设计：回顾性队列研究。目的：确定与脊髓损伤患者接受住院康复的功能恢复和住院时间相关的临床和人口学因素。地点：土耳其安卡拉比尔肯市医院物理医学和康复中心。方法：回顾性分析2020年1月至2023年9月住院康复的脊髓损伤患者的医疗记录。收集人口统计学特征、损伤相关变量、神经学水平、ASIA分类、SCIM III评分、并发症、辅助康复干预、膀胱管理和功能状态。进行单变量分析（Mann-Whitney U, Kruskal-Wallis，卡方），然后进行多变量回归以确定功能结局的独立预测因子。结果：共纳入342例患者，平均年龄38.9±16.2岁。平均住院时间为41.6±20.3天。单因素分析显示，年龄、损伤时间、神经系统水平、多次住院、SCIM III评分、并发症、先进的康复技术和膀胱导尿与功能状态和住院时间显著相关(p)。结论：年龄、神经完整性、并发症和膀胱管理是脊髓损伤康复中功能结局的关键决定因素，同时这些因素也影响住院时间。早期并发症预防、优化膀胱护理和量身定制的康复策略可促进康复和缩短住院时间。赞助：本研究未收到任何商业赞助。

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引用次数: 0

Evidence based recommendations for health professionals to improve care of people with spinal cord injury and cognitive impairment: an update to the psychosocial care practice guide 向卫生专业人员提出的改善脊髓损伤和认知障碍患者护理的循证建议：对社会心理护理实践指南的更新

IF 2.2 4区医学 Q3 CLINICAL NEUROLOGY

Spinal cord

Pub Date : 2025-11-25 DOI: 10.1038/s41393-025-01124-7

M. Arora, J. Middleton, AM. Sarandrea, I. Pozzato, C. McBain, D. Myles, Y. Tran, J. Kaur, A. Craig

Guidelines update. To provide management recommendations and strategies for cognitive impairment (CI) in people with spinal cord injury (SCI) for healthcare professionals (HCPs). SCI Units, NSW, Australia. The development encompassed multiple stages, commencing with establishment of the multidisciplinary advisory committee, followed by expert consultations. A rapid review and e-Delphi surveys were undertaken for the seven identified themes to achieve consensus for a new section on CI in an existing psychosocial guide. The intended primary end-user for this guide consists of the HCPs providing treatment to people with SCI in the acute, rehabilitation, and community settings. The secondary end-user includes consumer organisations, health planners, and policy makers. The expert consultation resulted in developing seven key themes to provide a foundational structure to the guidance about CI. For the first round of the Delphi survey, 40 (out of 49) statements received agreement levels exceeding 95% and were accepted without revisions. In the second round, two statements were deleted, and seven statements were amended based on the feedback received. After the final round, a total of 47 statements were accepted and formed 20 recommendations under seven themes as the final version of the cognitive guide. This updated guidance for managing CI in people with SCI emphasises the importance of person-centred care and the identification of barriers and facilitators for improved communication between the multidisciplinary HCPs and patients with SCI and their family members. This will ultimately enhance overall rehabilitation outcomes including self-efficacy, adjustment, and quality of life.

研究设计：指南更新。目的：为医疗保健专业人员（HCPs）提供脊髓损伤（SCI）患者认知功能障碍（CI）的管理建议和策略。地点：澳大利亚新南威尔士州SCI单位。方法：从建立多学科咨询委员会开始，经过专家会诊，分多个阶段进行。对七个确定的主题进行了快速审查和e-Delphi调查，以便就现有社会心理指南中关于CI的新章节达成共识。本指南的主要最终用户包括在急性、康复和社区环境中为脊髓损伤患者提供治疗的医护人员。二级终端用户包括消费者组织、卫生规划人员和政策制定者。结果：专家咨询产生了七个关键主题，为CI指导提供了基础结构。在第一轮德尔菲调查中，49个陈述中有40个获得了超过95%的同意水平，并且没有修改就被接受了。在第二轮中，根据收到的反馈意见，删除了两项陈述，修改了七项陈述。经过最后一轮的评审，共有47份陈述被接受，并形成了7个主题下的20条建议，作为认知指南的最终版本。结论：这一更新的SCI患者CI管理指南强调了以人为本的护理的重要性，以及多学科HCPs与SCI患者及其家庭成员之间改善沟通的障碍和促进因素的识别。这将最终提高整体康复结果，包括自我效能、适应能力和生活质量。

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引用次数: 0

Development of the international spinal cord injury psychological functioning basic data set 国际脊髓损伤心理功能基础数据集的建立。

IF 2.2 4区医学 Q3 CLINICAL NEUROLOGY

Spinal cord

Pub Date : 2025-11-24 DOI: 10.1038/s41393-025-01144-3

Marcel W. M. Post, Denise G. Tate, Sara Ahmed, Susan J. Bartlett, Susan Charlifue, Jennifer Coker, Ashley Craig, Stanley Ducharme, Jane Duff, Allen W. Heinemann, Duygu Kuzu, Kimberley R. Monden, Dan Rohe, Tijn van Diemen, Kathy Zebracki

Consensus exercise, narrative review. To create an International Spinal Cord Injury Psychological Functioning Basic Data Set (PSYCHBDS). International working group. Online meetings and email communications throughout 2020-2022. The authors reviewed measures used by SCI rehabilitation psychologists and reported in the literature. Selected measures and their psychometric properties were described. Consensus was reached on the measures and other data elements to include in the PSYCHBDS. The draft-PSYCHBDS was further reviewed by members of the International SCI Data Sets Committee, the American Spinal Injury Association (ASIA) Board, the International Spinal Cord Society (ISCoS) Executive and Scientific Committees, individual reviewers and societies, and posted on the ASIA and ISCoS websites for 1 month to elicit comments before final approval by ASIA and ISCoS. The group agreed to restrict the scope of the PSYCHBDS to the domains of anxiety and depressed mood and to use the 2-item versions of the Patient Health Questionnaire (PHQ) and the Generalized Anxiety Disorder (GAD). The PSYCHBDS consists of six standard and three optional data elements: date of data collection, professional background of data collector (optional), presence of psychological disorders before the onset of SCI, administration mode, PHQ-2 score, PHQ-9 score (optional), GAD-2 score, GAD-7 score (optional), and therapy for current psychological disorders. A data collection form and scoring instructions were developed. An international working group of experts achieved consensus on a data set to collect basic information on psychological factors and recommends its use in SCI/D rehabilitation and research.

研究设计：共识练习，叙述性回顾。目的：建立国际脊髓损伤心理功能基本数据集（PSYCHBDS）。背景：国际工作组。方法：2020-2022年期间在线会议和电子邮件沟通。作者回顾了脊髓损伤康复心理学家使用的测量方法和文献报道。描述了所选择的测量方法及其心理测量特性。会议就将纳入心理疾病分类系统的措施和其他数据要素达成了共识。该草案由国际SCI数据集委员会、美国脊髓损伤协会（ASIA）理事会、国际脊髓学会（ISCoS）执行委员会和科学委员会成员、个人审稿人和学会进一步审查，并在ASIA和ISCoS网站上发布1个月以征求意见，然后由ASIA和ISCoS最终批准。结果：小组同意将心理健康量表的范围限制在焦虑和抑郁情绪的领域，并使用患者健康问卷（PHQ）和广泛性焦虑障碍（GAD）的2项版本。PSYCHBDS包括6项标准数据和3项可选数据：数据收集日期、数据采集人员的专业背景（可选）、脊髓损伤发病前是否存在心理障碍、给药方式、PHQ-2评分、PHQ-9评分（可选）、GAD-2评分、GAD-7评分（可选）、当前心理障碍的治疗情况。制定了数据收集表和评分说明。结论：一个国际专家工作组就收集心理因素基本信息的数据集达成共识，并推荐其在SCI/D康复和研究中的应用。

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引用次数: 0

Vitamin D supplementation has no effect on bone mineral density in individuals with chronic spinal cord injury – results from a randomized controlled trial 补充维生素D对慢性脊髓损伤患者的骨密度没有影响——来自一项随机对照试验的结果。

IF 2.2 4区医学 Q3 CLINICAL NEUROLOGY

Spinal cord

Pub Date : 2025-11-20 DOI: 10.1038/s41393-025-01145-2

Anneke Hertig-Godeschalk, Joelle L. Flueck, Claudio Perret, Anke Scheel-Sailer, Martin W. G. Brinkhof, Rajeev K. Verma

Randomized, placebo-controlled, double-blind, parallel-group, superiority trial. Sufficient vitamin D levels (serum 25(OH)D > 75 nmol/L) are essential for bone health. The prevalence of insufficient 25(OH)D levels and osteoporosis is high in individuals with spinal cord injury (SCI). This study presents secondary outcomes from the VitD-SCI trial, which evaluated the effect of two D3 supplementation doses over a 12-month period on bone mineral density (BMD) in individuals with chronic SCI. Swiss SCI clinic. Forty-two individuals living with SCI for at least three years (seven females, mean age 48 ± 10 years, 18 ± 13 years since SCI onset) and having insufficient 25(OH)D levels were included. Participants were randomized to receive placebo, medium-dose (24'000 IU once every four weeks), or high-dose (24'000 IU once every two weeks) D3 supplementation for 12 months. At baseline and 12 months, 25(OH)D levels and BMD (measured at the radius, femoral neck, distal femur, and proximal tibia) were assessed. Thirty-three percent of participants who received supplementation achieved sufficient 25(OH)D levels. No effect of D3 supplementation on BMD was observed when comparing baseline to 12 months, regardless of the measurement site. None of the investigated parameters, including lesion level or smoking status, modified the effect under examination. Twelve months of D3 supplementation showed no effect on BMD in individuals with chronic SCI. This study highlights the complexity of SCI-specific physiological mechanisms that may interfere with the response to D3 supplementation and its impact on bone health in this population.

研究设计：随机、安慰剂对照、双盲、平行组、优势试验。目的：足够的维生素D水平（血清25(OH)D bb0 - 75 nmol/L）对骨骼健康至关重要。在脊髓损伤（SCI）患者中，25(OH)D水平不足和骨质疏松症的患病率很高。本研究介绍了VitD-SCI试验的次要结果，该试验评估了在12个月的时间内两次补充D3剂量对慢性SCI患者骨矿物质密度（BMD）的影响。地点：瑞士SCI诊所。方法：选取42例SCI患者（女性7例，平均年龄48±10岁，SCI发病18±13年），25(OH)D水平不足。参与者随机接受安慰剂、中剂量（每四周一次24000国际单位）或高剂量（每两周一次24000国际单位）D3补充剂，持续12个月。在基线和12个月时，评估25(OH)D水平和骨密度（在桡骨、股骨颈、股骨远端和胫骨近端测量）。结果：33%接受补充剂的参与者达到了足够的25(OH)D水平。无论测量部位如何，当比较基线和12个月时，没有观察到补充D3对BMD的影响。所有被调查的参数，包括病变程度或吸烟状况，都没有改变检查中的效果。结论：12个月的维生素D3补充对慢性脊髓损伤患者的骨密度没有影响。这项研究强调了sci特异性生理机制的复杂性，可能会干扰对D3补充的反应及其对该人群骨骼健康的影响。

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引用次数: 0

Prevalence of prescribed opioid claims among persons with non-traumatic spinal cord dysfunction in Ontario, Canada: a population-based retrospective cohort study 在加拿大安大略省非创伤性脊髓功能障碍患者中处方阿片类药物索赔的患病率：一项基于人群的回顾性队列研究。

IF 2.2 4区医学 Q3 CLINICAL NEUROLOGY

Spinal cord

Pub Date : 2025-11-15 DOI: 10.1038/s41393-025-01140-7

Qi Guan, Mary-Ellen Hogan, Andrew Calzavara, Daniel McCormack, Aisha K. Lofters, Tejal Patel, Sander L. Hitzig, Tanya Packer, Sara J. T. Guilcher

Cohort study. To determine the prevalence and to identify predictors of prescription opioid use among persons with non-traumatic spinal cord dysfunction within one year after discharge from inpatient rehabilitation. Ontario, Canada. We conducted a retrospective cohort study using administrative data to determine predictors of receiving prescription opioids during the one year after discharge from inpatient rehabilitation among persons with non-traumatic spinal cord dysfunction between April 1, 2004 and March 31, 2015. We modelled the outcome using a Poisson multivariable regression and reported relative risks with 95% confidence intervals. We identified 3468 individuals with non-traumatic spinal cord dysfunction (50.35% male) with 66.58% who were aged ≥66. Over half of the cohort (59.46%) received opioids during the observation period. Being female, previous opioid use before rehabilitation, increasing comorbidity level, low functional status, and having a previous diagnosis of osteoarthritis were significant risk factors for receiving opioids after discharge, as shown in an adjusted multivariable analysis. Increasing length of rehabilitation stay was protective against opioid receipt after discharge. Risk of receiving opioids varied with age. Younger individuals had a significantly higher risk of future opioid use, a risk that peaked around 30–40 years of age (aRR 1.54, 95% CI 1.42–1.67 for age 40, as compared to age 80). Risk of opioid use following discharge decreased as age increased beyond 40 years, as compared to age 80. Many individuals with non-traumatic spinal cord dysfunction in Ontario are prescribed opioids after discharge from inpatient rehabilitation. This may be problematic due to the number of severe complications that may arise from opioid use and their use in this population warrants future research.

研究设计：队列研究。目的：确定非创伤性脊髓功能障碍患者住院康复出院后一年内处方阿片类药物使用的患病率并确定预测因素。环境：加拿大安大略省。方法：我们利用行政数据进行了一项回顾性队列研究，以确定2004年4月1日至2015年3月31日期间非创伤性脊髓功能障碍患者出院后一年内接受处方阿片类药物治疗的预测因素。我们使用泊松多变量回归对结果进行建模，并以95%的置信区间报告相对风险。结果：我们确定了3468例非创伤性脊髓功能障碍患者（50.35%为男性），其中66.58%年龄≥66岁。超过一半的队列（59.46%）在观察期间接受了阿片类药物治疗。经调整的多变量分析显示，作为女性，康复前曾使用阿片类药物，合并症水平增加，功能状态低，既往诊断为骨关节炎是出院后服用阿片类药物的重要危险因素。增加康复时间对出院后阿片类药物的使用有保护作用。接受阿片类药物的风险随年龄而变化。年轻人未来使用阿片类药物的风险明显更高，风险在30-40岁左右达到顶峰（40岁的aRR为1.54,95% CI为1.42-1.67，与80岁相比）。出院后使用阿片类药物的风险随着年龄的增长而下降，超过40岁，与80岁相比。结论：安大略省许多非创伤性脊髓功能障碍患者在住院康复出院后服用阿片类药物。这可能是有问题的，因为阿片类药物的使用可能会引起严重的并发症，而且在这一人群中的使用值得未来的研究。

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引用次数: 0