Spinal Cord Series and Cases最新文献

Study design: A methodological study.

Objectives: To establish the criterion-related validity of the Nepali version of the Spinal Cord Independence Measure Self-Report (SCIM-SR).

Setting: Outpatient Department of the Spinal Injury Rehabilitation Center and community of Province no. 3, Nepal.

Methods: Community-dwelling individuals with spinal cord injury were enrolled. Participants self-administered the Nepali version of the SCIM-SR while a clinician concurrently administered the SCIM III. Descriptive statistics characterized the sample, while Spearman's rank correlation coefficient and Intraclass correlation coefficient assessed the association between the SCIM III and the Nepali version of the SCIM-SR. Bland Altman's analysis determined the differences.

Results: The Spearman's rank correlation coefficient for the total score was 0.961, self-care subscale was 0.590, respiration and sphincter management subscale was 0.897, and mobility subscale was 0.891. The ICC (2,1) and confidence interval for the total score, self-care subscale, respiration and sphincter management subscale, and mobility subscale were 0.989 (0.983-0.993), 0.873 (0.804-0.918), 0.955 (0.931-0.971) and 0.991 (0.987-0.994), respectively. The SCIM-SR scores were lower than the SCIM III in total and all subscale scores. The Bland-Altman's difference for the total score, self-care subscale, respiration and sphincter management subscale, and mobility subscale were 2.55, 1.34, 0.83, and 0.38, respectively.

Conclusions: The Nepali version of the SCIM-SR was validated and can be used to evaluate the functional status of individuals with spinal cord injury in the community setting of Nepal.

Study design: Retrospective analysis of clinical routine data.

Objectives: Spinal meningioma is a common type of benign spinal tumor. Surgical removal is the standard therapeutic approach. While surgery is generally associated with excellent outcomes, little is known about the rehabilitation outcome of patients with postoperative deficits. Therefore, we aim to describe the clinical features and rehabilitation outcomes of patients after surgical removal of spinal meningioma.

Setting: Region of Swabia, Bavaria, Germany.

Methods: We conducted a retrospective analysis of patients with spinal meningioma who underwent a rehabilitation program for patients with non-traumatic spinal cord injury at our department over the past five years. In addition to routine data, we focussed on analysing the Barthel Index, SCIM III score, and ASIA impairment scale before and after rehabilitation.

Results: 15 patients were included in the analysis. While most of them only had a few restrictions relevant to activities of daily living, some had severely limited walking ability. The predominant clinical feature was incomplete paraplegia with or without neurogenic bladder and bowel affection. The Barthel Index and SCIM III score demonstrated positive changes in the majority of cases, while alterations in the ASIA impairment scale were observed in a minority.

Conclusion: Considering the results of outcome parameters, rehabilitation treatment appears effective for these patients. Nonetheless, further studies with larger patient cohorts are necessary to confirm these findings.

Study design: Case Series OBJECTIVES: To provide an updated understanding of the incidence of surgically managed Traumatic Spinal Cord Injury (TSCI) in Singapore and to identify factors affecting discharge disposition.

Setting: Patients were identified from two level one trauma centres in Singapore.

Methods: All patients who underwent surgical management for acute TSCI between January 2020 to December 2021 were included. Demographics, injury details, peri-operative condition, hospital length of stay (LOS) and discharge disposition were evaluated. The overall characteristics of TSCI were summarised using descriptive statistics. The difference between discharge destinations was compared using chi-square test or t test. Variables with p values < 0.3 were selected for multivariable analysis.

Results: Forty-four patients were included. Median age was 65. The most common SCI aetiology was fall from standing height or less (54.6%). Accidents involving personal mobility devices, bicycles and motor vehicles made up the next largest group (20.5%). Thirty-nine cases (88.6%) involved the cervical region. There were two cases of inpatient mortality. Twenty-one patients (50%) were discharged home, 21 (50%) were discharged to a community hospital (CH) or nursing home (NH). The median LOS in an acute hospital was 41 days. Multivariable logistic regression analysis revealed that functional independence measure (FIM) score on discharge was an independent factor that influenced discharge disposition (p = 0.037).

Conclusion: A public health focus on falls prevention, the development of geriatric spinal rehabilitation programs, and the consideration of a national registry are recommended for the comprehensive management of TSCI in Singapore.

Introduction: Spinal cord infarction is a rare but often devastating disorder. The pathogenesis of most non-surgical cases involves atherothrombosis and treatment with anticoagulation and antiplatelet agents may be indicated. Functional recovery in most cases is poor. We describe five cases of spinal cord infarction and provide details on their functional outcomes after long-term (>10 years) follow-up.

Case presentation: A 28-year-old female presented at 16 weeks gestation with chest and back pain and paraesthesia in her fingers. Magnetic resonance imaging on admission revealed a spinal cord lesion extending from C5-T8. She was treated with anticoagulation and rehabilitation. Six years following presentation she was able to return to work. A 42-year-old male experiencing central chest pain and leg weakness was initially diagnosed as having acute coronary syndrome. Following discharge, he was re-admitted with urinary retention and leg weakness. Magnetic resonance imaging revealed a spinal cord lesion extending from T4 to T7. He was treated with anticoagulation, and eight months following presentation he regained full muscle strength but required intermittent self-catherisation. Three further cases are described.

Discussion: The aetiology of non-surgical spinal cord infarction is not always evident, but is commonly associated with atherothrombosis. There are often delays in making a diagnosis, but early recognition and prompt treatment of spinal cord infarction is essential. Long-term functional outcomes are often poor and typically reflect the severity of initial presentation. This case series is unique as it has one of the longest follow-up periods described in the literature.

Study design: A systematic review and meta-analysis OBJECTIVE: To determine the global frequency of osteomyelitis in individuals with spinal cord injury who have pressure injuries (SCI-PI).

Methods: A comprehensive search on PubMed, EMBASE, Scopus, and the Web of Science has been conducted until November 2023. The Cochrane Handbook for Systematic Reviews was followed. Cohort and cross-sectional studies included SCI-PI participants who reported the frequency of osteomyelitis without language restriction. Data extraction was performed by four reviewers in two groups. We used the Newcastle-Ottawa Quality Assessment Scale for quality assessment. The Chi-squared and I² tests were applied to detect heterogeneity between studies. Also, a random-effects model was performed for the report data.

Results: Ten out of 986 studies met our eligibility criteria, with 492 SCI-PI individuals. It was discovered that most SCIs were thoracolumbar injuries and male. There was a history of PI in more than half the patients. SCI was primarily caused by trauma. A meta-analysis revealed a significantly heterogeneous 43.0% osteomyelitis frequency. There was no evidence of publication bias. Subgroup analysis based on study quality revealed that the frequency of osteomyelitis in low-quality studies was 34.5%, whereas the frequency in high-quality research was 47.4%. Furthermore, the overall frequency of osteomyelitis was 29.0% in the subgroup analysis of research carried out in the USA.

Conclusions: Our study highlights the significant burden of osteomyelitis among SCI-PI individuals. These findings underscore the pressing need for standardized diagnostic and management protocols to mitigate the morbidity associated with osteomyelitis in this vulnerable population.

Study design: Retrospective case series of 48 patients.

Objectives: This study's primary objective was to provide a clinical description of a group of individuals with a working diagnosis of idiopathic spinal cord herniation (ISCH). The secondary objectives were to appreciate the natural history of these patients and describe their clinical evolution with conservative or surgical management.

Setting: The study was carried out at l'Hôpital de l'Enfant-Jésus, CHU de Québec (Québec, Canada), a tertiary care university hospital.

Methods: This case series study is based on routinely collected data. Forty-eight (48) cases were identified as having an ISCH on MR imaging, between 2009 and 2019. Their medical files have been searched retrospectively. Patient characteristics were described according to their asymptomatic or symptomatic status.

Results: The mean age of patients at the time of diagnosis was 52.5 years. Most of the patients identified were asymptomatic (69%) and followed clinically. The main neurologic presentation for the symptomatic group was Brown-Séquard-like syndrome. 20% of the symptomatic patients were rapidly treated surgically after consultation with the neurosurgeon. The mean follow-up duration was 56 months for asymptomatic patients and 51 months for symptomatic patients. Most of our patients (41 out of 45) were considered stable or unchanged at follow-up. There was no neurological progression in all asymptomatic patients.

Conclusions: Our study shows that ISCH and its variants are not always symptomatic and may be a fortuitous finding. As the natural history may be non-progressive, it is probably appropriate to treat some cases expectantly.

Study design: Longitudinal observational study. Measurements were undertaken between weeks 4-6 post-spinal cord injury (SCI), repeated at week 8 and every 4 weeks thereafter until week 20 or rehabilitation discharge, whichever occurred first.

Objectives: Observe variation in measured resting energy expenditure (REE) and body composition in males undergoing SCI rehabilitation, compare REE with SCI-specific prediction equations incorporating fat-free mass (FFM), and explore the prevalence of clinical factors that may influence individual REE.

Setting: Spinal Injuries Unit, Brisbane, Queensland, Australia.

Methods: Indirect calorimetry was used to measure REE and bioimpedance spectroscopy to assess body composition. Four SCI-specific FFM-based REE and basal metabolic rate (BMR) prediction equations were compared to measured REE. A clinically significant change in REE was defined as +/- 10% difference from the week 4-6 measurement. Clinical factors that may affect REE variations were collected including infection, pressure injuries, autonomic dysreflexia, spasticity, and medications.

Results: Fifteen people participated (mean age 35 ± 13 years, 67% paraplegic). There was no statistically significant change in mean REE, weight, or body composition, and the Chun and Nightingale BMR prediction equations performed best (r_c > 0.8 at all time points). One-third of participants had >10% change in REE on 11 occasions, with clinical factors not consistently associated with the observed changes.

Conclusion: During SCI rehabilitation, mean REE, weight, and body composition remain unchanged, and FFM-based BMR prediction equations may be an acceptable alternative to indirect calorimetry. Future research designs should avoid single indirect calorimetry measures as snapshot data may not represent typical REE in this population.

Study design: Retrospective population based study on traumatic spinal cord injury (SCI) in Ireland.

Objectives: To gather the most recent epidemiological data prior to the implementation of a new national trauma strategy. Also, to consider if the COVID-19 pandemic impacted on SCI epidemiology in Ireland.

Setting: Republic of Ireland.

Methods: All patients with TSCI discharged from the National Rehabilitation Hospital (NRH), the national acute SCI unit and two neurosciences centres were included. The International Spinal Cord Injury Core Data Set was collected on all patients at discharge from rehabilitation between 2017 and 2022.

Results: Overall crude incidence of TSCI was 14 per million per year, ranging between 11.3 and 18.4. 12.7% of patients did not survive to discharge from hospital. In those completing rehabilitation, the mean age of injury onset was 50.1 years (SD 19.9). Males accounted for 75.7%. The most common impairment was incomplete tetraplegia, 45.3% of all TSCI. Leading aetiology was falls, 53.9% of injuries. Patients with incomplete tetraplegia and those whose cause of injury were falls were older than those with all other impairments and injury aetiologies (p < 0.001).

Conclusions: Overall incidence of TSCI is similar to our previous studies. Also similar is the predominant pattern of older people sustaining falls resulting in incomplete tetraplegia.

Introduction: Cauda equina syndrome (CES) related to beta thalassemia with extramedullary hematopoiesis is a rarely reported and challenging clinical presentation. A thorough literature review revealed only a limited number of documented cases, each demonstrating a variety of treatment modalities with divergent outcomes.

Case presentation: In this case, a 29-year-old male with beta thalassemia, undergoing frequent blood transfusions, and with a history of splenectomy, presented with 2 days of worsening in his lower back pain, extending to both lower limbs, numbness, and urinary incontinence. Following the ASIA ISNCSCI scoring system for physical assessment, there was a significant decrease in anal tone and perianal sensation, suggesting possible sacral nerve roots involvement, but no other upper or lower extremities sensory or motor deficits were detected. Provided with the patient history of frequent blood transfusion and Thalassemia for which hematology referral was promoted. Spinal MRI revealed extramedullary hematopoiesis, disc protrusion, and cauda equina compression.

Discussion: Spine surgery, including decompression and laminectomy, resulted in improved back pain and lower limb symptoms during the one-year follow-up. However, persistent sensory impairment and neurogenic bladder necessitated ongoing urological management. The absence of clear guidelines for the management of such cases underscores the need for further data collection and comprehensive outcome reviews.

Introduction

Patients with spinal cord injury/disorder (SCI/D) and neurogenic lower urinary tract dysfunction (NLUTD) are on a 16–28 folder higher risk for bladder cancer [1]. Whereas in the general population 90% of bladder tumors are transitional cell carcinoma (TCC) patients with NLUTD have a shift to squamous cell carcinoma with 36,8% and only 46.3% TCC [2]. In addition, there is a significant increase in the bladder cancer-specific death rate in SCI patients (3rd most common) compared to the general population (10th most common) [2]. Chronic inflammation and mechanical irritation by permanent indwelling catheters are discussed as risk factors for developing bladder cancer. Typical symptoms of bladder cancer are often absent in patients with NLUTD and a reliable screening has not been established.

Case presentation

We present a case series of six patients with SCI and with squamous cell carcinoma diagnosed in the last 5 years in our institution. In five patients, bladder management was performed by indwelling suprapubic catheters, one patient used reflex voiding. Three patients were diagnosed during the regular, annual neuro-urological check-up, the remaining due to increasing spasticity and autonomic dysregulation. Subsequently, five patients underwent cystectomy with ileal conduit or uretercutaneostomy, one patient refused further surgical treatment. Four patients died within one year after diagnosis.

Discussion

Squamous cell carcinoma of the bladder is more common in patients with NLUTD. Chronic inflammation and mechanical irritation may be the reasons for carcinoma genesis. A regular check including cystoscopy is strongly recommended to detect tumor development early.