Spinal Cord Series and Cases最新文献

Study design: Retrospective single-centre study on spinal cord injury/disease (SCI/D) persons with spasticity, treated with muscle flaps reconstruction for pressure injury (PI) between July 2013 and January 2022.

Objectives: PI is a common complication in SCI/D. Neuro-muscular (NM) blockade with botulinum toxin-A (BTX) and intrathecal baclofen were used to treat associated spasticity in the reconstruction with muscle flaps, because spasms can lead to flap detachment and failure of the reconstruction, and compared with drug treatment alone or no drug.

Setting: Tertiary Rehabilitation Hospital for SCI/D in Italy.

Methods: Data were extracted from medical records. The characteristics of the sample were summarized using absolute and percentage frequencies, median and interquartile range or mean ± standard deviation, as appropriate. Characteristics and outcomes of PI were reported using the PI as the unit of analysis. Categorical variables were compared between groups with and without BTX-NM blockade using the chi-squared test and continuous variables were compared using Mann-Whitney's test. Statistical analyses were carried out using Stata, version 18.0 (StataCorp LLC, 2023).

Results: In this study of 46 persons with 54 PIs, the treatment of spasticity consisted of medication, BTX-NM blockade and intrathecal baclofen. The use of BTX-NM was associated with a significantly lower minor complication rate (13.4% vs 59%, p = 0.003) and a significantly shorter time to complete recovery (44 vs 58 days, p = 0.006).

Conclusion: BTX-NM can be used to prevent muscle spasms and may lead to better outcomes by reducing the minor complication rates and time to recovery.

Introduction: Spinal cord injury (SCI) is a life-changing experience which can result in a substantial range of psychological challenges. Although anxiety is elevated following SCI, evidence suggests that it is underreported and underdiagnosed, with consequences for long-term physical and mental health. In the UK, Cognitive Behavioural Therapy (CBT) is recommended as the first-line intervention for anxiety. However, people with SCI often face additional and complex challenges, which can limit the efficacy of protocol-delivered CBT. Pre-injury vulnerabilities can compound psychological challenges by influencing primary and secondary appraisals and perceived manageability of injury, resulting in poorer mental health and rehabilitation outcomes.

Case presentation: A transdiagnostic treatment intervention using a SCI-specific adjustment model alongside CBT and Coping Effectiveness Training (CET) of an adult with post-injury anxiety and adjustment difficulties (as measured by the GAD-7 and the ADAPSS), and history of depression (as measured by the PHQ-9). Individual psychological treatment for anxiety maintenance cycles, low mood and reduction of threat appraisals are reported, alongside multidisciplinary collaboration to enhance engagement. Outcomes included improved symptoms of anxiety, reduction of loss appraisals and development of resilience appraisals.

Discussion: Case studies of psychological treatment are sparse within the SCI literature. This case provides a detailed application of one of the most recognised psychological treatment modalities - CBT - and its integration with CET within an adjustment model for SCI. This study also highlights the importance of providing psychological support, psychoeducation and self-management strategies for all individuals with SCI, that is not dependent upon the degree of psychological morbidity.

Introduction: Vertebral hemangioma (VH) is the most common angiomatous tumor usually asymptomatic and is incidentally noticed on MRI. The incidence of VH is rare in the pediatric population. The extraosseous extension is termed an Aggressive Vertebral Hemangioma (AVH) and these often need surgical management. Intraoperative stereotactic navigation for tumor excision helps in planning- localizing the tumor and delineating its margins.

Case presentation: A 14-year-old boy presented with thoracic myelopathy signs. The MRI scan suggests T1 and T2 hyperintense signals within the T6 vertebral body with extramedullary extradural space occupying the lesion. The CT scan showed a "polka dot" appearance. Preoperative endovascular embolization followed by surgical decompression with posterior instrumented stabilization under O-arm navigation and tumor excision was planned. Cystic extradural lesion excised and vertebroplasty done at T6 level. Histopathology slides confirmed hemangioma.

Discussion: The most common age of involvement is between 30 and 70 years it is rarely seen in the pediatric age group. To the best of our knowledge, fewer than 20 cases of pediatric aggressive vertebral hemangiomas have been reported. Based on a review of pediatric AVH only 4 patients have been treated with preoperative vascular embolization followed by surgical decompression and stabilization. O-arm navigated AVH excision and vertebroplasty has never been described in the literature; this being the first case. It also aids in the identification of tumor margins along with real-time monitoring of adequate resection.

Study design: Observational, longitudinal, prospective study.

Objectives: This study aimed to evaluate the effects of Nabiximols (Sativex®) on spasticity in chronic spinal cord injury (SCI) individuals refractory to conventional therapy. Secondary objectives included assessing its impact on functional independence, neuropathic pain, sleep quality, and depression.

Setting: Institute Guttmann, a neurorehabilitation hospital in Badalona, Catalonia (Spain).

Methods: Adult participants ( >18 years) with chronic SCI ( >6 months) and moderate to severe spasticity refractory to conventional treatments were recruited. All participants underwent baseline assessments and were followed up at one and two months after initiating treatment with nabiximols oromucosal spray, with individualised dose adjustments on a weekly basis. Assessed variables included spasticity, functional independence, neuropathic pain, sleep quality, depression, quality of life, and Patient Global Impression of Improvement (PGI-I).

Results: Statistically significant improvements in spasticity were observed after one month (VAS decrease of 30%, p < 0.001; MAS decrease of 60%, p = 0.001) and two months (VAS decrease of 30%, p < 0.001; MAS decrease of 52%, p = 0.011) of treatment. A positive PGI-I was reported in 67% of participants. However, no significant changes were noted in spasms frequency, functional independence, neuropathic pain, or sleep quality. No significant differences in spasticity change or non-motor symptoms were found between participants with complete and incomplete SCI.

Conclusions: Nabiximols may effectively reduce spasticity in individuals with SCI resistant to conventional therapies. Given the significant impact of spasticity associated with SCI, it could be considered a viable add-on therapy for this population.

Trial registry: This clinical trial is registered in the EudraCT database under the identifier 2022-001777-31.

Sponsorship: Almirall, S.A., Barcelona, Catalonia (Spain).

Study design: Retrospective review.

Objective: Surgical fixation of the pediatric subaxial cervical spine poses significant challenges due to a mismatch between rigid adult cervical spine hardware and the size and shape of bone in a young (below 8 years of age) cervical spine.

Setting: Arizona, USA.

Methods: We conducted a retrospective review of our experience with subaxial cervical spine screw fixation using adult type mandibular instrumentation in pediatric patients younger than 8 years, symptomatic from acute traumatic cervical spine injury during the period of 2007 through 2023.

Results: We identified 5 patients with the mean age of 4.4 years (range 2-6 years) who all had spinal cord injury with subluxation or dislocation at C6-7. All patients underwent posterior cervico-thoracic fixation with mandibular instrumentation from C2 to the upper thoracic spine. There was one complication of a right vertebral artery occlusion by screw placement, which did not cause harm. Suboptimal screw placement was detected in 18.4% of screws, but no revision was needed, since it was asymptomatic. All patients fused successfully without significant hardware failure. The mean time of follow up was 91 months ranging from 33-187 months.

Conclusions: Mandibular screw and plate fixation was effective to treat the acutely traumatic unstable subaxial cervical spine in the young pediatric population. The rate of suboptimal screw placement may be reduced by placing shorter screws into the lamina, pedicles, or facets if the plate hole does not align for a standard trajectory needed for lateral mass or pedicle screw placement.

Study design: Hospital-based retrospective epidemiological research.

Objectives: To describe the epidemiological and demographic characteristics of patients with traumatic spinal cord injury (TSCI) in Catalonia from 1972-2022.

Setting: Neurological university hospital in Catalonia.

Methods: All patients diagnosed with TSCI admitted to the hospital from 1972-2022 were retrospectively reviewed. Etiology categories, neurological level of injury, American Spinal Injury Association Impairment Scale (AIS), Functional Independence Measure (FIM), and crude incidence rates were analyzed.

Results: A total of 3092 individuals with TSCI met the criteria. The crude annual incidence rate was 0.94/100,000 inhabitants. Mean age rose significantly over the years, from 27.7 (SD = 10.9) during 1972-1981 to 41.8 (SD = 17.1) during 2012-2022. The proportion of females constantly increased during 1982-2022 (18.4-23.1%). Etiologies were traffic accidents (51.8%), falls (22.0%), sports (9.8%), work-related (9.1%), suicide attempts (4.6%) and violence (2.7%). The proportion of traffic accidents dropped from 62.4% during 1982-1991 to 37.5% during 2012-2022, whereas falls increased from 14.5% during 1982-1991 to 26.0% during 2012-2022. Suicide attempts was the only etiology constantly increasing during 1972-2022 from 1-8% and with highest proportion of females (55.9%). Thoracic injuries dropped from 57.9% (1972-1981) to 38.3% (2012-2022), while cervical injuries constantly increased up to 48.8% in 2012-2022 with AIS A cases dropping and AIS D increasing. During 2002-2022, the etiologies with highest proportion of poor motor FIM at admission were sports (68.9%) and falls (63.1%).

Conclusions: Our results suggest the need on prevention strategies specially addressing falls and female suicide attempts.

Study design: A retrospective case series analysing six cases of Charcot spinal arthropathy.

Objectives: To evaluate the etiology, clinical manifestations (e.g., pain, trunk instability, autonomic dysreflexia, spasticity), latency period before symptom onset, affected spinal regions, and treatment strategies for Charcot spinal arthropathy.

Setting: National Spinal Injury Centre, United Kingdom.

Methods: Data were collected and analysed from six patients diagnosed with Charcot spinal arthropathy. Variables examined included the etiology, clinical presentations, spinal regions affected, latency period, and outcomes of treatment approaches. Both conservative management and surgical intervention strategies were evaluated.

Results: Patients exhibited common clinical manifestations such as pain, loss of trunk control, autonomic dysreflexia, and spasticity, with varying latency periods before symptom onset. The thoracic spine was the most frequently affected region. Conservative management successfully stabilized symptoms in most cases, while surgical intervention was necessary in instances of severe trunk instability, refractory pain, or deformity impacting mobility.

Conclusion: Conservative management should be the initial treatment approach for Charcot spinal arthropathy. Surgical intervention is reserved for cases with significant clinical progression, such as unresolved pain, mobility restrictions due to trunk deformity, or urgent complications arising from spinal pathology.

Study design: Prospective Case Series.

Objectives: To determine the incidence of positive faecal occult blood test (FOBT) in people with spinal cord injury (SCI). We hypothesised that people with SCI have a higher false positive FOBT rate when compared to the general population due to the high prevalence of complications of chronic constipation, and colonic and anorectal trauma from instrumentation.

Setting: Hospital in Sydney, New South Wales, Australia.

Methods: A prospective study was conducted at a quaternary hospital with a dedicated spinal injuries unit. Enrolled individuals had two FOBT samples sent. Persons outside the age criteria, or with active per-rectal or vaginal bleeding, anorectal disease, haematuria, recent SCI or colonoscopy, or who had completed FOBT as part of the National Bowel Cancer Screening Program were excluded.

Results: A total of 20 people were included in the study with 50% testing positive on FOBT. Three persons agreed to proceed with colonoscopy. All persons who declined colonoscopy were due to perceived difficulty with procedure preparation. FOBTs were positive in 90% of those who reported rectal enema, digital simulation or manual evacuation as part of their bowel care.

Conclusion: People with SCI have higher rates of positive FOBT compared to the general Australian population whilst follow-up colonoscopy rates were low. Compliance may be improved by bowel preparation protocols. High rates of positive FOBT in this population may be related to complications of constipation and bowel care. Our results suggest that FOBT is not an accurate screening tool in this population.

Background: Intramedullary spinal cord metastasis (ISCM) is very rare. Symptoms from ISCM metastasis being the initial presentation are extremely rare.

Case presentation: We present a case of a 42-year-old woman without previous medical history who presented with complaints of progressive lower limb weakness of three weeks evolution. Neurological examination elicited a medullary syndrome, and physical examination showed a palpable mass on her right breast. A spinal MRI revealed a dorsal intramedullary tumor mass. A biopsy sample from the breast mass revealed the diagnosis of carcinoma. The diagnosis of an Intramedullary breast cancer metastasis (IMBCM) was made according to positron emission tomography. The patient received treatment with corticosteroids and radiation therapy without improvement, and she died, 3 months after the diagnosis.

Conclusions: As far as we know, this is the first reported case of IMBCM revealing a breast carcinoma. Although extremely rare, ISCM should be considered as a differential diagnosis of a spinal intramedullary lesion.

Introduction: Shoulder pain mostly due to high biomechanical load of the anterior-shoulder musculature is prevalent among manual wheelchair users with spinal cord injury or disorder (SCI/D). This case study showcases a novel pull-function attachment to the wheelchair that reverses the propulsion motion by pulling rather than pushing the wheelchair. Additionally, the study reports its preliminary usability and impact on shoulder pain.

Case presentation: Four individuals with SCI/D (median age: 33; 1 female) used the novel pull-function attachment to the manual wheelchair for six weeks. Usability (System Usability Scale; ranging from 1 = 'strongly disagree' to 5 = 'strongly agree') and daily usage time were assessed. Shoulder pain intensity was explored before and after the six weeks using the Wheelchair User's Shoulder Pain Index. Median usability scores were ≥3.0 for 5/6 items, indicating high usability of the assistive technology. Shoulder pain intensity was reduced in all participants at the post-test (median change: -6.3), with the change in shoulder pain exceeding the minimal detectable change for 2/3 participants.

Discussion: The results of this case study suggest high usability of the pull-function attachment to the wheelchair. The decreases in shoulder pain intensity reported following six weeks of use were noticeable and may have clinical relevance. This novel assistive technology that enables forward propulsion by pulling rather than pushing the wheelchair may therefore have the potential to reduce shoulder pain in manual wheelchair users with SCI/D.