Pub Date : 2025-10-09DOI: 10.1038/s41393-025-01121-w
Tammy J. Lea, Adam J. C. Harriman, James Hodson, Jonathan Weblin
Quality improvement project. To review outcomes for adult patients admitted to ICU with a cervical spinal cord injury (SCI) requiring mechanical ventilation (MV); develop a multimodal respiratory weaning intervention (MRWI); and assess its impact on patient outcomes. A Major Trauma Centre in the UK. A retrospective service evaluation was conducted in 2020 to establish patient characteristics and outcomes. The findings of this, along with a literature review were used to develop a MRWI, comprising: a readiness to wean proforma; an adaptation of the Respiratory Information in Spinal Cord Injuries (RISCI) guidelines; and a weekly SCI ward round. The MRWI was implemented, with a second prospective service evaluation performed between January 2022 and January 2025. The primary outcome was the level of MV weaning at ICU discharge; secondary outcomes included compliance with assessments of diaphragm excursion with lung thoracic ultrasound (LUS) and respiratory mechanics. The pre- and post-MRWI service evaluations included N = 12 and N = 33 patients, respectively. The MRWI was associated with significantly higher compliance with assessments of LUS (82% [27/33] vs. 25% [3/12], p < 0.001) and respiratory mechanics (e.g. maximal inspiratory pressure: 48% [16/33] vs. 0% [0/12], p = 0.003). There was a non-significant tendency for higher rates of liberation from MV in ICU after the MRWI (79% [23/29] vs. 50% [6/12], p = 0.067); this was statistically significant for the C2-C4 SCI subgroup (78% [14/18] vs. 20% [1/5], p = 0.032). This QIP provides some evidence that implementing a MRWI may improve weaning outcomes in cervical SCIs admitted to ICU.
{"title":"A multimodal respiratory weaning intervention for adult critical care patients mechanically ventilated with cervical spinal cord injury: a quality improvement project","authors":"Tammy J. Lea, Adam J. C. Harriman, James Hodson, Jonathan Weblin","doi":"10.1038/s41393-025-01121-w","DOIUrl":"10.1038/s41393-025-01121-w","url":null,"abstract":"Quality improvement project. To review outcomes for adult patients admitted to ICU with a cervical spinal cord injury (SCI) requiring mechanical ventilation (MV); develop a multimodal respiratory weaning intervention (MRWI); and assess its impact on patient outcomes. A Major Trauma Centre in the UK. A retrospective service evaluation was conducted in 2020 to establish patient characteristics and outcomes. The findings of this, along with a literature review were used to develop a MRWI, comprising: a readiness to wean proforma; an adaptation of the Respiratory Information in Spinal Cord Injuries (RISCI) guidelines; and a weekly SCI ward round. The MRWI was implemented, with a second prospective service evaluation performed between January 2022 and January 2025. The primary outcome was the level of MV weaning at ICU discharge; secondary outcomes included compliance with assessments of diaphragm excursion with lung thoracic ultrasound (LUS) and respiratory mechanics. The pre- and post-MRWI service evaluations included N = 12 and N = 33 patients, respectively. The MRWI was associated with significantly higher compliance with assessments of LUS (82% [27/33] vs. 25% [3/12], p < 0.001) and respiratory mechanics (e.g. maximal inspiratory pressure: 48% [16/33] vs. 0% [0/12], p = 0.003). There was a non-significant tendency for higher rates of liberation from MV in ICU after the MRWI (79% [23/29] vs. 50% [6/12], p = 0.067); this was statistically significant for the C2-C4 SCI subgroup (78% [14/18] vs. 20% [1/5], p = 0.032). This QIP provides some evidence that implementing a MRWI may improve weaning outcomes in cervical SCIs admitted to ICU.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 11","pages":"579-587"},"PeriodicalIF":2.2,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-06DOI: 10.1038/s41393-025-01119-4
Anestis Divanoglou, Erik Berndtsson, Tomasz Tasiemski, Carolina Saskia Fellinghauer, Sophie Jörgensen
Longitudinal prospective cohort study. To assess the effects of Active Rehabilitation (AR) training programmes for individuals with spinal cord injury (SCI) on physical independence, self-efficacy and wheelchair skills, and to identify factors that are associated with gains in these outcomes. Eight consecutive AR programmes in Sweden. Participants (n = 111) with traumatic or nontraumatic SCI, aged 16 years and older, were evaluated at the start (T1) and completion (T2) of the programme, and at 3-month follow-up (T3). Assessments included standardised self-reported outcome measures (T1-T2-T3) and a practical wheelchair skills test (T1-T2). After attending the short, intensive peer-led AR programmes, participants reported gains in physical independence, especially in dressing and washing, bowel management, bed mobility, and transfers. Wheelchair skills improved, while improvements in aspects of self-efficacy and resilience were observed only at programme completion. Gains in physical independence and self-reported wheelchair skills were present at the 3-month follow-up. With few exceptions, examined predictors did not explain the observed outcome gains. AR programmes offer an effective, low-cost opportunity to improve essential and challenging aspects of physical independence and wheelchair skills among community-dwelling individuals with SCI. Immediate gains in aspects of self-efficacy and resilience–though not sustained at follow-up–may provide an initial momentum for future behavioural change, particularly among individuals who struggle to adjust to life after SCI. These findings strongly support the inclusion of intensive, residential, community-based peer-led programmes as a key component of the rehabilitation continuum for people with SCI.
{"title":"Effects of community peer-led programmes for people with spinal cord injury in Sweden–the INTERnational project for the evaluation of active rehabilitation (INTER-PEER)","authors":"Anestis Divanoglou, Erik Berndtsson, Tomasz Tasiemski, Carolina Saskia Fellinghauer, Sophie Jörgensen","doi":"10.1038/s41393-025-01119-4","DOIUrl":"10.1038/s41393-025-01119-4","url":null,"abstract":"Longitudinal prospective cohort study. To assess the effects of Active Rehabilitation (AR) training programmes for individuals with spinal cord injury (SCI) on physical independence, self-efficacy and wheelchair skills, and to identify factors that are associated with gains in these outcomes. Eight consecutive AR programmes in Sweden. Participants (n = 111) with traumatic or nontraumatic SCI, aged 16 years and older, were evaluated at the start (T1) and completion (T2) of the programme, and at 3-month follow-up (T3). Assessments included standardised self-reported outcome measures (T1-T2-T3) and a practical wheelchair skills test (T1-T2). After attending the short, intensive peer-led AR programmes, participants reported gains in physical independence, especially in dressing and washing, bowel management, bed mobility, and transfers. Wheelchair skills improved, while improvements in aspects of self-efficacy and resilience were observed only at programme completion. Gains in physical independence and self-reported wheelchair skills were present at the 3-month follow-up. With few exceptions, examined predictors did not explain the observed outcome gains. AR programmes offer an effective, low-cost opportunity to improve essential and challenging aspects of physical independence and wheelchair skills among community-dwelling individuals with SCI. Immediate gains in aspects of self-efficacy and resilience–though not sustained at follow-up–may provide an initial momentum for future behavioural change, particularly among individuals who struggle to adjust to life after SCI. These findings strongly support the inclusion of intensive, residential, community-based peer-led programmes as a key component of the rehabilitation continuum for people with SCI.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 11","pages":"567-578"},"PeriodicalIF":2.2,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41393-025-01119-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-04DOI: 10.1038/s41393-025-01122-9
Ümit Yalçın, Fatih Bağcıer, Pınar Öztop Çiftkaya, Burcu Çınar, Ali Kaan Öztürk, Esra Nur Güçlü, Burak Tayyip Dede, Burcu Hazer, Evrim Coşkun
A cross sectional study. This study aimed to assess the earthquake experiences, perceived safety, and psychological impact—specifically anxiety and post-traumatic stress levels—among individuals with SCI following the 6.2-magnitude Istanbul earthquake on April 23, 2025. A tertiary referral hospital in Istanbul, Turkey, where hospitalized and community-dwelling individuals with spinal cord injury (SCI) were evaluated on the fifth day following the April 2025 earthquake. A total of 64 participants, including hospitalized SCI patients (n = 19), community-dwelling SCI patients (n = 22), and able-bodied controls (n = 23), were evaluated within five days of the disaster. Demographic data, housing characteristics, and disaster experiences were recorded. Psychological assessment included the Beck Anxiety Inventory (BAI), the Impact of Event Scale-Revised (IES-R), and a 10-item perceived safety scale. SCI participants had significantly higher BAI scores compared to able-bodied individuals (p < 0.05). Hospitalized SCI patients reported lower anxiety levels than their community-dwelling counterparts. No significant differences were found regarding mobility level, location (European vs. Asian side), building age, or number of floors. A strong correlation was observed between anxiety and post-traumatic stress symptoms (r = 0.770, p < 0.001). Given the low participant numbers, our data suggests that SCI individuals may be more psychologically affected by earthquakes than able-bodied peers, regardless of functional independence or physical environment. Hospitalization during disaster may offer protective psychological benefits. These findings highlight the importance of integrating psychosocial support and tailored disaster preparedness strategies for individuals with SCI.
{"title":"Psychosocial impact and anxiety determinants in individuals with spinal cord injury following the april 2025 istanbul earthquake: perceptions of safety and early post-disaster experience","authors":"Ümit Yalçın, Fatih Bağcıer, Pınar Öztop Çiftkaya, Burcu Çınar, Ali Kaan Öztürk, Esra Nur Güçlü, Burak Tayyip Dede, Burcu Hazer, Evrim Coşkun","doi":"10.1038/s41393-025-01122-9","DOIUrl":"10.1038/s41393-025-01122-9","url":null,"abstract":"A cross sectional study. This study aimed to assess the earthquake experiences, perceived safety, and psychological impact—specifically anxiety and post-traumatic stress levels—among individuals with SCI following the 6.2-magnitude Istanbul earthquake on April 23, 2025. A tertiary referral hospital in Istanbul, Turkey, where hospitalized and community-dwelling individuals with spinal cord injury (SCI) were evaluated on the fifth day following the April 2025 earthquake. A total of 64 participants, including hospitalized SCI patients (n = 19), community-dwelling SCI patients (n = 22), and able-bodied controls (n = 23), were evaluated within five days of the disaster. Demographic data, housing characteristics, and disaster experiences were recorded. Psychological assessment included the Beck Anxiety Inventory (BAI), the Impact of Event Scale-Revised (IES-R), and a 10-item perceived safety scale. SCI participants had significantly higher BAI scores compared to able-bodied individuals (p < 0.05). Hospitalized SCI patients reported lower anxiety levels than their community-dwelling counterparts. No significant differences were found regarding mobility level, location (European vs. Asian side), building age, or number of floors. A strong correlation was observed between anxiety and post-traumatic stress symptoms (r = 0.770, p < 0.001). Given the low participant numbers, our data suggests that SCI individuals may be more psychologically affected by earthquakes than able-bodied peers, regardless of functional independence or physical environment. Hospitalization during disaster may offer protective psychological benefits. These findings highlight the importance of integrating psychosocial support and tailored disaster preparedness strategies for individuals with SCI.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 11","pages":"599-606"},"PeriodicalIF":2.2,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-30DOI: 10.1038/s41393-025-01116-7
K. E. Tranter, L. A. Harvey, J. Ross, B. Wadsworth, D. J. Berlowitz, E. A. Bye, L. W. Chen, H. Patterson, M. McDonald, S. Calthorpe, J. Agostinello, E. Gollan, S. Denis, L. Blecher, D. Wilson, J. Peach, T. McDonald, M. Walters, J. Mather, L. Davis, M. D’Cruz, J. V. Glinsky
Development of respiratory recommendations in a Clinical Practice Guideline (CPG). (i) To describe the evidence recommendations and consensus-based opinion statements for the effectiveness of respiratory interventions to improve respiratory muscle strength, lung volumes and secretion clearance. (ii) To outline the clinical rationale for these recommendations and statements. Australia and New Zealand Sixteen clinical questions relating to respiratory interventions for people with spinal cord injury (SCI) were presented in PICO format (Participant, Intervention, Comparison, Outcome) and decided a-priori by a respiratory guideline committee. Systematic reviews were conducted to answer each of the questions using rigorous methodology to synthesise evidence from randomised controlled trials. Evidence was assessed for risk of bias and quality using Grading of Recommendations Assessment Development and Evaluation (GRADE). Details were presented to a guideline panel who voted on each question and developed either an evidence recommendation or a consensus-based opinion statement. Eighteen randomised controlled trials met the inclusion criteria and were relevant for eight questions. Three of these trials had interventions and outcomes relevant to more than one question. Overall, ten, eight and two trials answered questions related to improving respiratory muscle strength, lung volumes and secretion clearance, respectively. The Australian and New Zealand CPGs for the physiotherapy management of people with SCI ( www.sciptguide.com ) provide evidence recommendations and consensus-based opinion statements to inform respiratory management of people with SCI.
{"title":"Physiotherapy interventions for the respiratory management of people with spinal cord injury: recommendations from an Australian and New Zealand clinical practice guideline","authors":"K. E. Tranter, L. A. Harvey, J. Ross, B. Wadsworth, D. J. Berlowitz, E. A. Bye, L. W. Chen, H. Patterson, M. McDonald, S. Calthorpe, J. Agostinello, E. Gollan, S. Denis, L. Blecher, D. Wilson, J. Peach, T. McDonald, M. Walters, J. Mather, L. Davis, M. D’Cruz, J. V. Glinsky","doi":"10.1038/s41393-025-01116-7","DOIUrl":"10.1038/s41393-025-01116-7","url":null,"abstract":"Development of respiratory recommendations in a Clinical Practice Guideline (CPG). (i) To describe the evidence recommendations and consensus-based opinion statements for the effectiveness of respiratory interventions to improve respiratory muscle strength, lung volumes and secretion clearance. (ii) To outline the clinical rationale for these recommendations and statements. Australia and New Zealand Sixteen clinical questions relating to respiratory interventions for people with spinal cord injury (SCI) were presented in PICO format (Participant, Intervention, Comparison, Outcome) and decided a-priori by a respiratory guideline committee. Systematic reviews were conducted to answer each of the questions using rigorous methodology to synthesise evidence from randomised controlled trials. Evidence was assessed for risk of bias and quality using Grading of Recommendations Assessment Development and Evaluation (GRADE). Details were presented to a guideline panel who voted on each question and developed either an evidence recommendation or a consensus-based opinion statement. Eighteen randomised controlled trials met the inclusion criteria and were relevant for eight questions. Three of these trials had interventions and outcomes relevant to more than one question. Overall, ten, eight and two trials answered questions related to improving respiratory muscle strength, lung volumes and secretion clearance, respectively. The Australian and New Zealand CPGs for the physiotherapy management of people with SCI ( www.sciptguide.com ) provide evidence recommendations and consensus-based opinion statements to inform respiratory management of people with SCI.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 11","pages":"588-598"},"PeriodicalIF":2.2,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41393-025-01116-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-25DOI: 10.1038/s41393-025-01120-x
Nele Bertels, Yvonne Janssen-Potten, Charlotte van Laake-Geelen, Kathleen Borgions, Kristine Oostra, Annemie Spooren
Longitudinal observational study. To explore motor training strategies, therapy dosage, and motivation in subacute arm-hand rehabilitation for individuals with cervical spinal cord injury and their change over a 6-month rehabilitation period. Three rehabilitation centers in Belgium and the Netherlands. Individuals with lesions between C1-Th1 and AIS A–D were included between 4–8 weeks post-injury and observed for three weeks with an eight-week interval. Regular arm-hand training sessions, with at least 25% arm-hand training, were analyzed. Motor training strategies, therapy dosage, and motivation were collected by two trained observers, video recordings and patient-reported outcome measures. 240 Sessions from thirteen participants (mean age 54.4 ± 12.9; C1-C5; AIS B–D) were included. Analytical training showed the highest active arm-hand use (30.3%), followed by skill training (26.6%). Of the 15 task-oriented components, only multiple movement planes, functional movements, and feedback were used in ≥60% of sessions. Actual session time averaged 78.3% of the planned duration. During the arm-hand session, 52.1% of the time involved active time. Skill training showed the lowest number of repetitions (MED: 66.5). Participants reported low physical fatigue (4/10) and difficulty (4/10) but high motivation (7/10). Limited changes in training variables were observed over six months. Our findings reveal a gap between clinical practice and evidence-based guidelines for arm-hand training. Despite its importance, skill training and key task-oriented components are underused. Low perceived difficulty and intensity, contrasted with high motivation, suggest the potential to increase therapy doses for better rehabilitation outcomes.
{"title":"Arm-hand training strategies and therapy dose dimensions during the subacute rehabilitation of people with cervical spinal cord injury: a longitudinal observational study","authors":"Nele Bertels, Yvonne Janssen-Potten, Charlotte van Laake-Geelen, Kathleen Borgions, Kristine Oostra, Annemie Spooren","doi":"10.1038/s41393-025-01120-x","DOIUrl":"10.1038/s41393-025-01120-x","url":null,"abstract":"Longitudinal observational study. To explore motor training strategies, therapy dosage, and motivation in subacute arm-hand rehabilitation for individuals with cervical spinal cord injury and their change over a 6-month rehabilitation period. Three rehabilitation centers in Belgium and the Netherlands. Individuals with lesions between C1-Th1 and AIS A–D were included between 4–8 weeks post-injury and observed for three weeks with an eight-week interval. Regular arm-hand training sessions, with at least 25% arm-hand training, were analyzed. Motor training strategies, therapy dosage, and motivation were collected by two trained observers, video recordings and patient-reported outcome measures. 240 Sessions from thirteen participants (mean age 54.4 ± 12.9; C1-C5; AIS B–D) were included. Analytical training showed the highest active arm-hand use (30.3%), followed by skill training (26.6%). Of the 15 task-oriented components, only multiple movement planes, functional movements, and feedback were used in ≥60% of sessions. Actual session time averaged 78.3% of the planned duration. During the arm-hand session, 52.1% of the time involved active time. Skill training showed the lowest number of repetitions (MED: 66.5). Participants reported low physical fatigue (4/10) and difficulty (4/10) but high motivation (7/10). Limited changes in training variables were observed over six months. Our findings reveal a gap between clinical practice and evidence-based guidelines for arm-hand training. Despite its importance, skill training and key task-oriented components are underused. Low perceived difficulty and intensity, contrasted with high motivation, suggest the potential to increase therapy doses for better rehabilitation outcomes.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 10","pages":"557-565"},"PeriodicalIF":2.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41393-025-01120-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Retrospective cohort study Ventrally located cervical spinal meningiomas present significant surgical challenges due to their proximity to the spinal cord and nerve roots. This study aimed to evaluate the surgical outcomes of these tumors resected via the posterior approach and to compare them with dorsolaterally located meningiomas. The single institution in Japan. A retrospective review was conducted on 39 patients who underwent posterior surgical resection of cervical spinal meningiomas between 2008 and 2023, with a minimum follow-up of one year. Patients were classified into ventral (n = 17) and dorsolateral (n = 22) groups based on tumor localization. Neurological function was assessed using the Japanese Orthopedic Association (JOA) score, and surgical outcomes were compared. The groups had no significant differences in operative time or blood loss. However, nerve root resection was significantly more frequent in the ventral group (41.2 vs. 9.1%, p = 0.02), and perioperative complications and intraoperative motor-evoked potential amplitude reduction (35.3 vs. 4.5%, p = 0.03) were more common (41.2 vs. 13.6%, p = 0.06). Although postoperative JOA scores were lower in the ventral group (14.6 ± 0.6 vs. 16.4 ± 0.3, p = 0.01), both groups showed significant postoperative improvement compared to preoperative scores (p < 0.01). Despite the higher risk of nerve root sacrifice and limited neurological recovery associated with the posterior approach, considering the functional improvements from baseline, it remains a viable surgical option for ventrally located cervical meningiomas. Further studies comparing different surgical approaches are needed to optimize treatment strategies.
{"title":"Surgical outcomes of ventrally located cervical spinal meningiomas","authors":"Yuichiro Nishiyama, Narihito Nagoshi, Toshiki Okubo, Masahiro Ozaki, Satoshi Suzuki, Kazuki Takeda, Takahito Iga, Morio Matsumoto, Masaya Nakamura, Kota Watanabe","doi":"10.1038/s41393-025-01118-5","DOIUrl":"10.1038/s41393-025-01118-5","url":null,"abstract":"Retrospective cohort study Ventrally located cervical spinal meningiomas present significant surgical challenges due to their proximity to the spinal cord and nerve roots. This study aimed to evaluate the surgical outcomes of these tumors resected via the posterior approach and to compare them with dorsolaterally located meningiomas. The single institution in Japan. A retrospective review was conducted on 39 patients who underwent posterior surgical resection of cervical spinal meningiomas between 2008 and 2023, with a minimum follow-up of one year. Patients were classified into ventral (n = 17) and dorsolateral (n = 22) groups based on tumor localization. Neurological function was assessed using the Japanese Orthopedic Association (JOA) score, and surgical outcomes were compared. The groups had no significant differences in operative time or blood loss. However, nerve root resection was significantly more frequent in the ventral group (41.2 vs. 9.1%, p = 0.02), and perioperative complications and intraoperative motor-evoked potential amplitude reduction (35.3 vs. 4.5%, p = 0.03) were more common (41.2 vs. 13.6%, p = 0.06). Although postoperative JOA scores were lower in the ventral group (14.6 ± 0.6 vs. 16.4 ± 0.3, p = 0.01), both groups showed significant postoperative improvement compared to preoperative scores (p < 0.01). Despite the higher risk of nerve root sacrifice and limited neurological recovery associated with the posterior approach, considering the functional improvements from baseline, it remains a viable surgical option for ventrally located cervical meningiomas. Further studies comparing different surgical approaches are needed to optimize treatment strategies.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 10","pages":"551-556"},"PeriodicalIF":2.2,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A retrospective cohort study using a nationwide Japanese inpatient database. To investigate the association between the timing of rehabilitation interventions and pressure ulcers requiring treatment in acute hospitalized patients with cervical spinal cord injuries between 2010 and 2022 in a real-world clinical setting. We used the Diagnosis Procedure Combination database, a nationwide Japanese inpatient database. We included patients with cervical spinal cord injury who underwent spinal surgery within 3 days of admission between July 2010 and March 2022. We defined rehabilitation within 2 days of surgery as early rehabilitation and ≥3 days of surgery as non-early rehabilitation. The primary outcome was pressure ulcers requiring treatment ≥4 days after admission, and the secondary outcomes were length of hospital stay, hospitalization costs, and in-hospital mortality. Propensity score inverse probability of treatment weighting was conducted to compare the outcomes between the early and non-early rehabilitation groups. We identified 5162 eligible patients, 3434 (66.1%) of whom underwent early rehabilitation. After weighting, the pressure ulcers requiring treatment showed no significant difference between the early and non-early rehabilitation groups (odds ratio, 1.42; 95% confidence interval [CI], 0.78–2.59; P = 0.249). The early rehabilitation group showed shorter length of hospital stay (difference, −7.4; 95% CI, −13.1–−1.3%; P = 0.018) than did the non-early rehabilitation group. This study found no significant difference in the pressure ulcers requiring treatment between the early and non-early rehabilitation groups.
研究设计：采用日本全国住院患者数据库进行回顾性队列研究。目的：在现实世界的临床环境中，研究2010年至2022年期间急性颈脊髓损伤住院患者康复干预时间与需要治疗的压疮之间的关系。设置：我们使用了诊断程序组合数据库，这是一个全国性的日本住院患者数据库。方法：我们纳入了2010年7月至2022年3月入院3天内接受脊柱手术的颈脊髓损伤患者。我们将手术2天内的康复定义为早期康复，手术≥3天的康复定义为非早期康复。主要结局是入院后≥4天需要治疗的压疮，次要结局是住院时间、住院费用和住院死亡率。采用倾向得分治疗加权逆概率法比较早期和非早期康复组的结果。结果：我们确定了5162例符合条件的患者，其中3434例（66.1%）接受了早期康复治疗。加权后，需要治疗的压疮在早期和非早期康复组之间无显著差异（优势比1.42；95%可信区间[CI]， 0.78-2.59; P = 0.249）。早期康复组的住院时间较非早期康复组短（差异为-7.4;95% CI, -13.1—1.3%;P = 0.018）。结论：本研究发现早期和非早期康复组在需要治疗的压疮方面无显著差异。
{"title":"Timing of rehabilitation and pressure ulcers requiring treatment during acute hospitalization in patients with cervical spinal cord injuries","authors":"Risa Yamauchi, Yusuke Sasabuchi, Shotaro Aso, Hideo Yasunaga","doi":"10.1038/s41393-025-01117-6","DOIUrl":"10.1038/s41393-025-01117-6","url":null,"abstract":"A retrospective cohort study using a nationwide Japanese inpatient database. To investigate the association between the timing of rehabilitation interventions and pressure ulcers requiring treatment in acute hospitalized patients with cervical spinal cord injuries between 2010 and 2022 in a real-world clinical setting. We used the Diagnosis Procedure Combination database, a nationwide Japanese inpatient database. We included patients with cervical spinal cord injury who underwent spinal surgery within 3 days of admission between July 2010 and March 2022. We defined rehabilitation within 2 days of surgery as early rehabilitation and ≥3 days of surgery as non-early rehabilitation. The primary outcome was pressure ulcers requiring treatment ≥4 days after admission, and the secondary outcomes were length of hospital stay, hospitalization costs, and in-hospital mortality. Propensity score inverse probability of treatment weighting was conducted to compare the outcomes between the early and non-early rehabilitation groups. We identified 5162 eligible patients, 3434 (66.1%) of whom underwent early rehabilitation. After weighting, the pressure ulcers requiring treatment showed no significant difference between the early and non-early rehabilitation groups (odds ratio, 1.42; 95% confidence interval [CI], 0.78–2.59; P = 0.249). The early rehabilitation group showed shorter length of hospital stay (difference, −7.4; 95% CI, −13.1–−1.3%; P = 0.018) than did the non-early rehabilitation group. This study found no significant difference in the pressure ulcers requiring treatment between the early and non-early rehabilitation groups.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 10","pages":"544-550"},"PeriodicalIF":2.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-17DOI: 10.1038/s41393-025-01108-7
Ángel Gil-Agudo, Francisco Gutiérrez Henares, Sauro Biscotto, Antonio Rodriguez Sotillo, Mª Elena Ferreiro Velasco, Bosco Méndez Ferrer, Jesús Benito Penalva, Joan Vidal Samsó, Albert Borau Duran, Giulio del Popolo, Salvatore Petrozzino, Ernesto Losavio, Maria Giuseppa Onesta, Michele Spinelli
Prospective, descriptive, analytical, observational study involving 12 multicenter, international centers from Spain and Italy. Determine the method for bladder voiding in spinal cord injury (SCI) patients concerning different intrinsic and environmental variables. Neurogenic bladder is common in spinal cord injury (SCI) patients, profoundly impacting their quality of life. While clean intermittent catheterization (CIC) is the preferred method due to fewer complications and infections and improved quality of life, alternative methods like indwelling catheterization or condom catheters are viable options for bladder management. Data was gathered along the acute (at hospital admission), subacute (expectations at discharge) and hospital discharge phases. Data from 266 SCI patients was gathered. Main procedure for bladder voiding at the time of admission was indwelling catheterization (n = 242, 91.0%) and CIC was the most used procedure at discharge (n = 122, 45.9%). CIC is the preferred procedure when the evaluation of expectations at discharge is done (n = 181, 68.6%). The probability of achieving reflex voiding at discharge was higher as the American Spinal Injury Association (ASIA) Impairment Scale score improved (p < 0.001). A relationship was established with the level of injury (p < 0.001) and body mass index (p = 0.017), in addition to marital status, age and history of depression. Initial information about CIC was mostly provided by the urologist (n = 137, 73.3%) while training was predominantly done by the nurse (n = 159, 87.8%). Differences in neurogenic bladder management were identified regarding level and injury severity, SCIM, BMI, marital status, age and depression history. B Braun Medical S.A.U.
{"title":"Monitoring of neurogenic bladder management from hospital admission until discharge in spinal cord injury units: the SIRCA study","authors":"Ángel Gil-Agudo, Francisco Gutiérrez Henares, Sauro Biscotto, Antonio Rodriguez Sotillo, Mª Elena Ferreiro Velasco, Bosco Méndez Ferrer, Jesús Benito Penalva, Joan Vidal Samsó, Albert Borau Duran, Giulio del Popolo, Salvatore Petrozzino, Ernesto Losavio, Maria Giuseppa Onesta, Michele Spinelli","doi":"10.1038/s41393-025-01108-7","DOIUrl":"10.1038/s41393-025-01108-7","url":null,"abstract":"Prospective, descriptive, analytical, observational study involving 12 multicenter, international centers from Spain and Italy. Determine the method for bladder voiding in spinal cord injury (SCI) patients concerning different intrinsic and environmental variables. Neurogenic bladder is common in spinal cord injury (SCI) patients, profoundly impacting their quality of life. While clean intermittent catheterization (CIC) is the preferred method due to fewer complications and infections and improved quality of life, alternative methods like indwelling catheterization or condom catheters are viable options for bladder management. Data was gathered along the acute (at hospital admission), subacute (expectations at discharge) and hospital discharge phases. Data from 266 SCI patients was gathered. Main procedure for bladder voiding at the time of admission was indwelling catheterization (n = 242, 91.0%) and CIC was the most used procedure at discharge (n = 122, 45.9%). CIC is the preferred procedure when the evaluation of expectations at discharge is done (n = 181, 68.6%). The probability of achieving reflex voiding at discharge was higher as the American Spinal Injury Association (ASIA) Impairment Scale score improved (p < 0.001). A relationship was established with the level of injury (p < 0.001) and body mass index (p = 0.017), in addition to marital status, age and history of depression. Initial information about CIC was mostly provided by the urologist (n = 137, 73.3%) while training was predominantly done by the nurse (n = 159, 87.8%). Differences in neurogenic bladder management were identified regarding level and injury severity, SCIM, BMI, marital status, age and depression history. B Braun Medical S.A.U.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 10","pages":"530-537"},"PeriodicalIF":2.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41393-025-01108-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Retrospective multicenter study. To identify predictors associated with failure of neurological improvement after posterior decompression surgery for degenerative cervical myelopathy (DCM). 17 institutions in Japan. Patients who underwent posterior decompression surgery and were followed up for >1 year were enrolled. The Japanese Orthopedic Association (JOA) recovery rate was determined, and patients were divided into three outcome groups based on the JOA recovery rate: fair (recovery rate, <22.2%: mean-1SD), moderate (22.3%–77.1%), and good (>77.2%: mean+1 SD) groups. Demographic information, postoperative complications, and radiographic parameters were assessed, and predictors of poor outcomes were identified using the multinominal logistic regression analysis. Of 868 patients enrolled, 140 (16.1%), 586 (67.5%), and 142 (16.3%) were assigned to the fair, moderate, and good groups, respectively, with mean JOA recovery rates of 6.2% ± 13.7%, 50.1% ± 15.0%, and 90.6% ± 8.3%. Although there were significant differences in the frequency of diabetes mellitus among the three groups in the univariate analysis (26.4% vs. 23.0% vs. 14.1%; p = 0.03), the multinominal regression analysis revealed that old age was a significant independent predictor of poor outcomes in the comparison between the fair and good groups (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.27–2.07; p < 0.01). Old age was also significantly associated with failure of neurological improvement between the fair and moderate groups (OR, 1.35; 95% CI 1.15–1.59; p < 0.01). Old age may be an independent predictor of failure of neurological improvement after posterior decompression surgery in patients with DCM.
研究设计：回顾性多中心研究。目的：确定与退行性颈椎病（DCM）后路减压术后神经系统改善失败相关的预测因素。背景：日本17所院校。方法：采用后路减压术，随访10年。测定日本骨科协会（JOA）的康复率，并根据JOA康复率将患者分为3个结局组：公平组（康复率77.2%：平均+1 SD）。评估人口统计信息、术后并发症和影像学参数，并使用多项逻辑回归分析确定不良预后的预测因素。结果：纳入的868例患者中，一般组140例（16.1%），中等组586例（67.5%），良好组142例（16.3%），平均JOA恢复率分别为6.2%±13.7%,50.1%±15.0%和90.6%±8.3%。虽然在单因素分析中，三组患者的糖尿病发生率有显著差异（26.4% vs. 23.0% vs. 14.1%, p = 0.03），但多项回归分析显示，在公平组和良好组的比较中，年龄是不良预后的显著独立预测因子(优势比[OR]， 1.62； 95%可信区间[CI]， 1.27-2.07；结论：年龄可能是DCM患者后路减压术后神经系统改善失败的独立预测因素。
{"title":"Predictors of poor outcomes after posterior decompression surgery in patients with degenerative cervical myelopathy","authors":"Satoshi Suzuki, Narihito Nagoshi, Kanehiro Fujiyoshi, Ryoma Aoyama, Osahiko Tsuji, Eijiro Okada, Nobuyuki Fujita, Mitsuru Yagi, Takashi Tsuji, Kota Watanabe, Masaya Nakamura, Morio Matsumoto, Ken Ishii, Junichi Yamane","doi":"10.1038/s41393-025-01107-8","DOIUrl":"10.1038/s41393-025-01107-8","url":null,"abstract":"Retrospective multicenter study. To identify predictors associated with failure of neurological improvement after posterior decompression surgery for degenerative cervical myelopathy (DCM). 17 institutions in Japan. Patients who underwent posterior decompression surgery and were followed up for >1 year were enrolled. The Japanese Orthopedic Association (JOA) recovery rate was determined, and patients were divided into three outcome groups based on the JOA recovery rate: fair (recovery rate, <22.2%: mean-1SD), moderate (22.3%–77.1%), and good (>77.2%: mean+1 SD) groups. Demographic information, postoperative complications, and radiographic parameters were assessed, and predictors of poor outcomes were identified using the multinominal logistic regression analysis. Of 868 patients enrolled, 140 (16.1%), 586 (67.5%), and 142 (16.3%) were assigned to the fair, moderate, and good groups, respectively, with mean JOA recovery rates of 6.2% ± 13.7%, 50.1% ± 15.0%, and 90.6% ± 8.3%. Although there were significant differences in the frequency of diabetes mellitus among the three groups in the univariate analysis (26.4% vs. 23.0% vs. 14.1%; p = 0.03), the multinominal regression analysis revealed that old age was a significant independent predictor of poor outcomes in the comparison between the fair and good groups (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.27–2.07; p < 0.01). Old age was also significantly associated with failure of neurological improvement between the fair and moderate groups (OR, 1.35; 95% CI 1.15–1.59; p < 0.01). Old age may be an independent predictor of failure of neurological improvement after posterior decompression surgery in patients with DCM.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 10","pages":"538-543"},"PeriodicalIF":2.2,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-23DOI: 10.1038/s41393-025-01114-9
Armin Khavandegar, Negin Safari Dehnavi, Mario Ganau, Zahra Ramezani, Elaheh Khodadoust, Mahgol Sadat Hassan Zadeh Tabatabaei, Tahereh Maleki, Maryam Alsadat Mousavi, Kimia RayatSanati, Mahsa Esmaeili, Ayda Eslami Nejad Parizi, Amgad S. Hanna, Zahra Hassannejad, Michael G. Fehlings, Mahdi Sharif-Alhoseini
Systematic Review To systematically examine the use of bioengineered scaffolds, with/without bioactive agents, drugs, or cellular transplants in preclinical animal models and human studies of spinal cord injury (SCI). Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences A systematic review and meta-analysis was conducted following PRISMA guidelines and registered in PROSPERO (ID: CRD42023437266). A comprehensive search in MEDLINE and Embase on 8/27/2023 identified studies on scaffolds as neuroregenerative and neuroprotective treatments for SCI. Human studies were assessed using ROBINS-I, and meta-analysis focused on clinical outcomes. Of 4561 articles screened, 931 studies were included: in-vivo (82%), in-vitro (16%), and human studies (1%). Various biomaterials (N = 82; natural: 38%; synthetic: 62%), cell types (N = 27; NSCs: 24%, Schwann cells: 13%, NPCs: 12%), bioactive agents (N = 38; NT-3: 32%, BDNF: 25%, FGF: 24%), and pharmacological agents (N = 88; chABC: 12%, heparin: 11%, taxels: 10%) were analyzed. Fourteen human studies included acute and chronic SCI patients, with cervical (36%) and thoracic SCI (64%). Clinical trials demonstrated moderate to low quality (ROBINS-I). Our meta-analysis indicated that the pooled 2-scale AIS conversion rate was 30.59% (p = 0.005) ranging from 33.46% (p = 0.036) in acute to 28.35% (p = 0.084) in chronic SCI. Furthermore, the pooled 1-scale AIS conversion rate was 11.79% (p = 0.011), spanning from 17.31% (p = 0.131) in acute to 7.44% (p = 0.081) in chronic SCI. Scaffold implantation shows promising neuroregenerative potential, evidenced by AIS grade improvement in human studies. Scaffolds are advancing rapidly from laboratory research to clinical trials, expanding treatment options for SCI.
{"title":"Neuroregenerative and neuroprotective effects of bioengineered scaffolds in spinal cord injury: a systematic review of preclinical and early phase clinical studies","authors":"Armin Khavandegar, Negin Safari Dehnavi, Mario Ganau, Zahra Ramezani, Elaheh Khodadoust, Mahgol Sadat Hassan Zadeh Tabatabaei, Tahereh Maleki, Maryam Alsadat Mousavi, Kimia RayatSanati, Mahsa Esmaeili, Ayda Eslami Nejad Parizi, Amgad S. Hanna, Zahra Hassannejad, Michael G. Fehlings, Mahdi Sharif-Alhoseini","doi":"10.1038/s41393-025-01114-9","DOIUrl":"10.1038/s41393-025-01114-9","url":null,"abstract":"Systematic Review To systematically examine the use of bioengineered scaffolds, with/without bioactive agents, drugs, or cellular transplants in preclinical animal models and human studies of spinal cord injury (SCI). Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences A systematic review and meta-analysis was conducted following PRISMA guidelines and registered in PROSPERO (ID: CRD42023437266). A comprehensive search in MEDLINE and Embase on 8/27/2023 identified studies on scaffolds as neuroregenerative and neuroprotective treatments for SCI. Human studies were assessed using ROBINS-I, and meta-analysis focused on clinical outcomes. Of 4561 articles screened, 931 studies were included: in-vivo (82%), in-vitro (16%), and human studies (1%). Various biomaterials (N = 82; natural: 38%; synthetic: 62%), cell types (N = 27; NSCs: 24%, Schwann cells: 13%, NPCs: 12%), bioactive agents (N = 38; NT-3: 32%, BDNF: 25%, FGF: 24%), and pharmacological agents (N = 88; chABC: 12%, heparin: 11%, taxels: 10%) were analyzed. Fourteen human studies included acute and chronic SCI patients, with cervical (36%) and thoracic SCI (64%). Clinical trials demonstrated moderate to low quality (ROBINS-I). Our meta-analysis indicated that the pooled 2-scale AIS conversion rate was 30.59% (p = 0.005) ranging from 33.46% (p = 0.036) in acute to 28.35% (p = 0.084) in chronic SCI. Furthermore, the pooled 1-scale AIS conversion rate was 11.79% (p = 0.011), spanning from 17.31% (p = 0.131) in acute to 7.44% (p = 0.081) in chronic SCI. Scaffold implantation shows promising neuroregenerative potential, evidenced by AIS grade improvement in human studies. Scaffolds are advancing rapidly from laboratory research to clinical trials, expanding treatment options for SCI.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 9","pages":"451-469"},"PeriodicalIF":2.2,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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