Although multimodal intraoperative neuromonitoring (IONM), which has high sensitivity and specificity, is typically performed during spinal deformity surgery, neurological status may deteriorate with delay after surgical maneuvers. Here, we report a rare case of delayed postoperative neurological deficit (DPND) that was not detected by IONM during posterior spinal fusion (PSF) for congenital scoliosis.
Case presentation
A 14-year-old male presented with congenital scoliosis associated with T3 and T10 hemivertebrae. Preoperative Cobb angle of proximal thoracic (PT) and main thoracic (MT) curves were 50° and 41°, respectively. PSF (T1-L1) without hemivertebrectomy was performed, and the curves were corrected to 31° and 21° in the PT and MT curves, respectively, without any abnormal findings in IONM, blood pressure, or hemoglobin level. However, postoperative neurological examination revealed complete loss of motor function. A revision surgery, release of the curve correction by removing the rods, was immediately performed and muscle strength completely recovered on the first postoperative day. Five days postoperatively, PSF was achieved with less curve correction (36° in the PT curve and 26° in the MT curve), without postoperative neurological deficits.
Discussion
Possible mechanisms of DPND in our patient are spinal cord ischemia due to spinal cord traction caused by scoliosis correction and spinal cord kinking by the pedicle at the concave side. Understanding the possible mechanisms of intra- and postoperative neural injury is essential for appropriate intervention in each situation. Additionally, IONM should be continued to at least skin closure to detect DPND observed in our patient.
{"title":"Delayed paraparesis after posterior spinal fusion for congenital scoliosis: a case report","authors":"Shuhei Ohtsubo, Masayuki Ohashi, Toru Hirano, Hideki Tashi, Tatsuo Makino, Keitaro Minato, Yusuke Mitsuma, Hiroyuki Deguchi, Rintaro Hoshino, Nobuko Ohashi, Kenta Furutani, Hiroyuki Kawashima, Kei Watanabe","doi":"10.1038/s41394-024-00639-0","DOIUrl":"https://doi.org/10.1038/s41394-024-00639-0","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>Although multimodal intraoperative neuromonitoring (IONM), which has high sensitivity and specificity, is typically performed during spinal deformity surgery, neurological status may deteriorate with delay after surgical maneuvers. Here, we report a rare case of delayed postoperative neurological deficit (DPND) that was not detected by IONM during posterior spinal fusion (PSF) for congenital scoliosis.</p><h3 data-test=\"abstract-sub-heading\">Case presentation</h3><p>A 14-year-old male presented with congenital scoliosis associated with T3 and T10 hemivertebrae. Preoperative Cobb angle of proximal thoracic (PT) and main thoracic (MT) curves were 50° and 41°, respectively. PSF (T1-L1) without hemivertebrectomy was performed, and the curves were corrected to 31° and 21° in the PT and MT curves, respectively, without any abnormal findings in IONM, blood pressure, or hemoglobin level. However, postoperative neurological examination revealed complete loss of motor function. A revision surgery, release of the curve correction by removing the rods, was immediately performed and muscle strength completely recovered on the first postoperative day. Five days postoperatively, PSF was achieved with less curve correction (36° in the PT curve and 26° in the MT curve), without postoperative neurological deficits.</p><h3 data-test=\"abstract-sub-heading\">Discussion</h3><p>Possible mechanisms of DPND in our patient are spinal cord ischemia due to spinal cord traction caused by scoliosis correction and spinal cord kinking by the pedicle at the concave side. Understanding the possible mechanisms of intra- and postoperative neural injury is essential for appropriate intervention in each situation. Additionally, IONM should be continued to at least skin closure to detect DPND observed in our patient.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140609945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-16DOI: 10.1038/s41394-024-00635-4
John Mahon, Lily Nolan, David O’Sullivan, Mark Curtin, Aiden Devitt, Colin G. Murphy
Introduction
Powered robotic exoskeleton (PRE) physiotherapy programmes are a relatively novel frontier which allow patients with reduced mobility to engage in supported walking. Research is ongoing regarding their utility, risks, and benefits. This article describes the case of two fractures occurring in one patient using a PRE.
Case
We report the case of a 54 year old man who sustained bilateral tibial fractures while using a PRE, on a background of T10 AIS A SCI. The initial session was discontinued due to acute severe bilateral knee swelling after approximately 15 min. The patient attended their local hospital the following day, where radiographs demonstrated bilateral proximal tibial fractures. The patient was treated with manipulation under anaesthetic and long-leg casting for five weeks, at which point he was stepped down to hinged knee braces which were weaned gradually while he remained non-weight bearing for 12 weeks. The patient was investigated with DEXA scan and was diagnosed with osteoporosis. He was liaised with rheumatology services and bone protection was initiated. Fracture healing was achieved and weight-bearing precautions were discontinued, however this period of immobilisation led to significant spasticity. The patient was discharged from orthopaedic services, with ongoing rehabilitation and physiotherapy follow-up.
Conclusion
PRE assisted physiotherapy programmes are a promising concept in terms of rehabilitation and independence, however they are not without risk and it is important that both providers and patients are aware of this. Furthermore, SCI patients are at increased risk for osteoporosis and should be monitored and considered for bone protection.
导言:有动力机器人外骨骼(PRE)理疗计划是一个相对新颖的领域,它可以让行动不便的患者进行辅助行走。有关其效用、风险和益处的研究仍在进行中。我们报告了一名 54 岁男性患者的病例,他在使用 PRE 时发生了双侧胫骨骨折,其背景是 T10 AIS A SCI。最初的治疗在大约 15 分钟后因急性双侧膝关节严重肿胀而中断。第二天,患者到当地医院就诊,X 光片显示双侧胫骨近端骨折。患者在麻醉状态下接受了手法治疗,并进行了为期五周的长腿石膏固定,随后他被换上了铰链式膝关节支具,并在 12 周内一直保持不负重状态。患者接受了 DEXA 扫描检查,被诊断为骨质疏松症。他与风湿病部门取得了联系,并开始进行骨保护。骨折愈合后,患者停止了负重预防措施,但这段固定期导致了明显的痉挛。结论PRE辅助物理治疗计划在康复和独立性方面是一个很有前景的概念,但也不是没有风险,医疗服务提供者和患者都必须意识到这一点。此外,SCI 患者患骨质疏松症的风险增加,应进行监测并考虑保护骨骼。
{"title":"Bilateral tibial fractures associated with powered exoskeleton use in complete spinal cord injury – a case report & literature review","authors":"John Mahon, Lily Nolan, David O’Sullivan, Mark Curtin, Aiden Devitt, Colin G. Murphy","doi":"10.1038/s41394-024-00635-4","DOIUrl":"https://doi.org/10.1038/s41394-024-00635-4","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>Powered robotic exoskeleton (PRE) physiotherapy programmes are a relatively novel frontier which allow patients with reduced mobility to engage in supported walking. Research is ongoing regarding their utility, risks, and benefits. This article describes the case of two fractures occurring in one patient using a PRE.</p><h3 data-test=\"abstract-sub-heading\">Case</h3><p>We report the case of a 54 year old man who sustained bilateral tibial fractures while using a PRE, on a background of T10 AIS A SCI. The initial session was discontinued due to acute severe bilateral knee swelling after approximately 15 min. The patient attended their local hospital the following day, where radiographs demonstrated bilateral proximal tibial fractures. The patient was treated with manipulation under anaesthetic and long-leg casting for five weeks, at which point he was stepped down to hinged knee braces which were weaned gradually while he remained non-weight bearing for 12 weeks. The patient was investigated with DEXA scan and was diagnosed with osteoporosis. He was liaised with rheumatology services and bone protection was initiated. Fracture healing was achieved and weight-bearing precautions were discontinued, however this period of immobilisation led to significant spasticity. The patient was discharged from orthopaedic services, with ongoing rehabilitation and physiotherapy follow-up.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>PRE assisted physiotherapy programmes are a promising concept in terms of rehabilitation and independence, however they are not without risk and it is important that both providers and patients are aware of this. Furthermore, SCI patients are at increased risk for osteoporosis and should be monitored and considered for bone protection.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140610296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-13DOI: 10.1038/s41394-024-00636-3
Sina Shool, Saeed Rahmani, Mohammad Amin Habibi, Seyed Mohammad Piri, Mahmoud Lotfinia, Delara Jashnani, Sina Asaadi
Study design
Scoping systematic review.
Objectives
To summarize the available experimental clinical and animal studies for the identification of all CSF and serum-derived biochemical markers in human and rat SCI models.
Setting
Tehran, Iran.
Methods
In this scoping article, we systematically reviewed the electronic databases of PubMed, Scopus, WOS, and CENTRAL to retrieve current literature assessing the levels of different biomarkers in human and rat SCI models.
Results
A total of 19,589 articles were retrieved and 6897 duplicated titles were removed. The remaining 12,692 studies were screened by their title/abstract and 12,636 were removed. The remaining 56 were considered for full-text assessment, and 11 papers did not meet the criteria, and finally, 45 studies were included. 26 studies were human observational studies comprising 1630 patients, and 19 articles studied SCI models in rats, including 832 rats. Upon reviewing the literature, we encountered a remarkable heterogeneity in terms of selected biomarkers, timing, and method of measurement, studied models, extent, and mechanism of injury as well as outcome assessment measures.
Conclusions
The specific expression and distribution patterns of biomarkers in relation to spinal cord injury (SCI) phases, and their varied concentrations over time, suggest that cerebrospinal fluid (CSF) and blood biomarkers are effective measures for assessing the severity of SCI.
{"title":"Acute spinal cord injury serum biomarkers in human and rat: a scoping systematic review","authors":"Sina Shool, Saeed Rahmani, Mohammad Amin Habibi, Seyed Mohammad Piri, Mahmoud Lotfinia, Delara Jashnani, Sina Asaadi","doi":"10.1038/s41394-024-00636-3","DOIUrl":"https://doi.org/10.1038/s41394-024-00636-3","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Study design</h3><p>Scoping systematic review.</p><h3 data-test=\"abstract-sub-heading\">Objectives</h3><p>To summarize the available experimental clinical and animal studies for the identification of all CSF and serum-derived biochemical markers in human and rat SCI models.</p><h3 data-test=\"abstract-sub-heading\">Setting</h3><p>Tehran, Iran.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>In this scoping article, we systematically reviewed the electronic databases of PubMed, Scopus, WOS, and CENTRAL to retrieve current literature assessing the levels of different biomarkers in human and rat SCI models.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>A total of 19,589 articles were retrieved and 6897 duplicated titles were removed. The remaining 12,692 studies were screened by their title/abstract and 12,636 were removed. The remaining 56 were considered for full-text assessment, and 11 papers did not meet the criteria, and finally, 45 studies were included. 26 studies were human observational studies comprising 1630 patients, and 19 articles studied SCI models in rats, including 832 rats. Upon reviewing the literature, we encountered a remarkable heterogeneity in terms of selected biomarkers, timing, and method of measurement, studied models, extent, and mechanism of injury as well as outcome assessment measures.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>The specific expression and distribution patterns of biomarkers in relation to spinal cord injury (SCI) phases, and their varied concentrations over time, suggest that cerebrospinal fluid (CSF) and blood biomarkers are effective measures for assessing the severity of SCI.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140601644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To investigate the changes in the characteristics of cervical spinal cord injuries (CSCI) before and after the coronavirus disease 2019 (COVID-19) pandemic among patients transported to our hospital in Japan.
Setting
Hospital with an emergency center in Chiba, Japan.
Methods
Patients eligible for the study were those transported within 24 h of injury and diagnosed with cervical spinal cord injury between January 2018 and December 2021 at our hospital. Medical records were retrospectively examined to investigate the number and characteristics of patients with CSCI. The clinical variables of patients with CSCI were compared according to the time of admission as related to the COVID-19 pandemic: 2018-19 (before) or 2020-21 (after).
Results
The total number of patients with CSCI from 2018 to 2021 was 108, with 57 before the COVID-19 pandemic and 51 after the COVID-19 pandemic. The number of severe cases with an injury severity score (ISS) of >16 decreased after COVID-19 (p < 0.05). Falls on level surfaces were the most common cause of injury both before and after COVID-19. Although the ranking of traffic accidents decreased after COVID-19, among those, the number of bicycle injuries tended to increase.
Conclusions
The number of serious cases with an ISS > 16 decreased, presumably because of the decline in high-energy trauma due to the background decrease in the number of traffic accidents.
研究设计横断面研究.Objections To investigate the changes in the characteristics of cervical spinal cord injuries (CSCI) before and after the coronavirus disease 2019 (COVID-19) pandemic among patients transported to our hospital in Japan.SettingHospital with an emergency center in Chiba, Japan.MethodsPatients eligible to the study were those transported within 24 h of injury and diagnosed with cervical spinal cord injury between January 2018 and December 2021 at our hospital.研究方法符合研究条件的患者是在我院2018年1月至2021年12月期间受伤后24小时内转运并被诊断为颈脊髓损伤的患者。通过回顾性研究病历,调查了CSCI患者的数量和特征。根据与COVID-19大流行相关的入院时间:2018-19年(之前)或2020-21年(之后),对CSCI患者的临床变量进行比较。结果2018年至2021年的CSCI患者总数为108例,其中57例在COVID-19大流行之前,51例在COVID-19大流行之后。受伤严重程度评分(ISS)为>16的重症病例数量在COVID-19大流行后有所减少(p< 0.05)。在 COVID-19 之前和之后,在平地摔倒是最常见的受伤原因。虽然 COVID-19 后交通事故的排名有所下降,但其中自行车受伤的数量却呈上升趋势。结论 ISS 为 16 分的严重病例数量有所下降,这可能是由于交通事故数量下降导致高能量创伤减少。
{"title":"Trend differences in cervical spinal cord injuries before and after the coronavirus disease 2019 pandemic","authors":"Hirotaka Fukushima, Chikara Ushiku, Shoshi Akiyama, Shinji Saito, Hiroki Wakiya, Kenji Okuno, Mitsuru Saito","doi":"10.1038/s41394-024-00633-6","DOIUrl":"https://doi.org/10.1038/s41394-024-00633-6","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Study design</h3><p>Cross-Sectional Study.</p><h3 data-test=\"abstract-sub-heading\">Objectives</h3><p>To investigate the changes in the characteristics of cervical spinal cord injuries (CSCI) before and after the coronavirus disease 2019 (COVID-19) pandemic among patients transported to our hospital in Japan.</p><h3 data-test=\"abstract-sub-heading\">Setting</h3><p>Hospital with an emergency center in Chiba, Japan.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Patients eligible for the study were those transported within 24 h of injury and diagnosed with cervical spinal cord injury between January 2018 and December 2021 at our hospital. Medical records were retrospectively examined to investigate the number and characteristics of patients with CSCI. The clinical variables of patients with CSCI were compared according to the time of admission as related to the COVID-19 pandemic: 2018-19 (before) or 2020-21 (after).</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The total number of patients with CSCI from 2018 to 2021 was 108, with 57 before the COVID-19 pandemic and 51 after the COVID-19 pandemic. The number of severe cases with an injury severity score (ISS) of >16 decreased after COVID-19 (<i>p</i> < 0.05). Falls on level surfaces were the most common cause of injury both before and after COVID-19. Although the ranking of traffic accidents decreased after COVID-19, among those, the number of bicycle injuries tended to increase.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>The number of serious cases with an ISS > 16 decreased, presumably because of the decline in high-energy trauma due to the background decrease in the number of traffic accidents.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140601639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-10DOI: 10.1038/s41394-024-00630-9
S. L. Sørensen, I. Poulsen, L. A. Harvey, F. Biering-Sørensen, J. F. Nielsen
Study design
Feasibility study.
Objective
To determine the feasibility of conducting a large trial designed to determine whether the ROBERT® can be used to increase the strength of the hip flexor muscles after spinal cord injury (SCI). The ROBERT® is a robotic device that provides assisted active movement while supporting the weight of the leg. Focus was on recruitment capability, suitability, and acceptability of the intervention and outcome measure.
Setting
Specialised SCI centre in Denmark.
Methods
All first-time admitted patients were screened to assess participant recruitment capability. Four people with SCI < 3 months tested a protocol consisting of 60 repetitions of hip flexion in supine conducted with the assistance of the ROBERT® three times a week for 4 weeks. Feasibility was assessed based on adherence to the protocol and completion rate and from the participants’ perspectives. Maximal voluntary contraction (MVC) was accessed at baseline and four weeks.
Results
The recruitment rate was 8% (7 months). The four participants completed 44 out of 48 sessions (92%). No adverse events occurred. One physiotherapist was required to set-up and supervise each session. The active exercise time varied from 7.5 to 17 min. The participants found the ROBERT® a good supplement to their usual rehabilitation. We were able to measure MVC in even very weak hip flexor muscles with a dynamometer MicroFET2 fixed to a frame.
Conclusion
The ROBERT® was feasible and acceptable. The participants perceived it as a supplement, not a replacement to usual physiotherapy. However, recruitment to the study was slow.
Trial registration
ClinicalTrials.gov NCT05558254. Registered 28th September 2022.
{"title":"Robotic technology (ROBERT®) to enhance muscle strength in the hip flexor muscles following spinal cord injury: a feasibility study","authors":"S. L. Sørensen, I. Poulsen, L. A. Harvey, F. Biering-Sørensen, J. F. Nielsen","doi":"10.1038/s41394-024-00630-9","DOIUrl":"https://doi.org/10.1038/s41394-024-00630-9","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Study design</h3><p>Feasibility study.</p><h3 data-test=\"abstract-sub-heading\">Objective</h3><p>To determine the feasibility of conducting a large trial designed to determine whether the ROBERT<sup>®</sup> can be used to increase the strength of the hip flexor muscles after spinal cord injury (SCI). The ROBERT<sup>®</sup> is a robotic device that provides assisted active movement while supporting the weight of the leg. Focus was on recruitment capability, suitability, and acceptability of the intervention and outcome measure.</p><h3 data-test=\"abstract-sub-heading\">Setting</h3><p>Specialised SCI centre in Denmark.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>All first-time admitted patients were screened to assess participant recruitment capability. Four people with SCI < 3 months tested a protocol consisting of 60 repetitions of hip flexion in supine conducted with the assistance of the ROBERT<sup>®</sup> three times a week for 4 weeks. Feasibility was assessed based on adherence to the protocol and completion rate and from the participants’ perspectives. Maximal voluntary contraction (MVC) was accessed at baseline and four weeks.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The recruitment rate was 8% (7 months). The four participants completed 44 out of 48 sessions (92%). No adverse events occurred. One physiotherapist was required to set-up and supervise each session. The active exercise time varied from 7.5 to 17 min. The participants found the ROBERT<sup>®</sup> a good supplement to their usual rehabilitation. We were able to measure MVC in even very weak hip flexor muscles with a dynamometer MicroFET2 fixed to a frame.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>The ROBERT<sup>®</sup> was feasible and acceptable. The participants perceived it as a supplement, not a replacement to usual physiotherapy. However, recruitment to the study was slow.</p><h3 data-test=\"abstract-sub-heading\">Trial registration</h3><p>ClinicalTrials.gov NCT05558254. Registered 28th September 2022.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140601667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-08DOI: 10.1038/s41394-024-00631-8
Anuj Gupta, Mayukh Guha, Kuldeep Bansal
Introduction
Pneumorrachis is presence of air in the epidural space. It could be the result of trauma, barotrauma, iatrogenic or spontaneous. The pneumorrachis per se is an underdiagnosed entity as most of the patients are asymptomatic or have subclinical symptoms. The spontaneous occurrence of pneumorrachis has been reported in literature but giant spontaneous occurrence causing cauda equina syndrome has not been reported so far.
Case presentation
We report a case of 56-year-old male patient who came to our OPD on wheelchair with complains of difficulty in walking for 6 months with dribbling of urine for 2 months with on and off back pain. His perianal sensation was reduced with absent voluntary anal contraction. Imaging revealed giant air pockets in the spinal canal of L5-S1 extending upto L4-L5. It was managed surgically wherein laminectomy without fusion was done. The patient responded well to the treatment.
Discussion
There are many causes of pneumorrachis described in literature. Most of the cases of pneumorrachis are asymptomatic and incidentally diagnosed. With the improvement in radio-diagnostic modalities, the diagnosis of pneumorrachis can be easily established. When symptomatic, they can be managed conservatively. Those presenting with neurological deficit may require surgical intervention or other invasive intervention.
{"title":"A rare case of spontaneous giant pneumorrachis presenting with cauda equina syndrome: a case report","authors":"Anuj Gupta, Mayukh Guha, Kuldeep Bansal","doi":"10.1038/s41394-024-00631-8","DOIUrl":"https://doi.org/10.1038/s41394-024-00631-8","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>Pneumorrachis is presence of air in the epidural space. It could be the result of trauma, barotrauma, iatrogenic or spontaneous. The pneumorrachis per se is an underdiagnosed entity as most of the patients are asymptomatic or have subclinical symptoms. The spontaneous occurrence of pneumorrachis has been reported in literature but giant spontaneous occurrence causing cauda equina syndrome has not been reported so far.</p><h3 data-test=\"abstract-sub-heading\">Case presentation</h3><p>We report a case of 56-year-old male patient who came to our OPD on wheelchair with complains of difficulty in walking for 6 months with dribbling of urine for 2 months with on and off back pain. His perianal sensation was reduced with absent voluntary anal contraction. Imaging revealed giant air pockets in the spinal canal of L5-S1 extending upto L4-L5. It was managed surgically wherein laminectomy without fusion was done. The patient responded well to the treatment.</p><h3 data-test=\"abstract-sub-heading\">Discussion</h3><p>There are many causes of pneumorrachis described in literature. Most of the cases of pneumorrachis are asymptomatic and incidentally diagnosed. With the improvement in radio-diagnostic modalities, the diagnosis of pneumorrachis can be easily established. When symptomatic, they can be managed conservatively. Those presenting with neurological deficit may require surgical intervention or other invasive intervention.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140602165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-05DOI: 10.1038/s41394-024-00626-5
Louise C. Kelly, Joanne V. Glinsky, Lisa A. Harvey
Introduction
Historically, bladder washouts were used to instil therapeutic reagents directly into the bladder. This practice has expanded to include instillation of solutions that deal with catheter issues such as encrustation or formation of bio-film. They appear to provide a promising strategy for people with long term catheters. These products are readily available to purchase, but there is concern that people are using these solutions without a complete understanding of the purpose for the rinse and without clinical guidance to monitor response to treatment.
Case presentation
These case studies include three people living with spinal cord injury (SCI) who developed severe autonomic dysreflexia (AD) when a catheter rinse was carried out using a particular solution. Each of the cases developed immediate and, in some cases, intractable AD requiring further intervention to resolve symptoms.
Discussion
Catheter-associated urinary tract infection is a significant cause of morbidity and mortality in people living with SCI. Long-term catheters provide a vector for opportunistic micro-organisms to form bio-film and create an environment that promotes formation of struvite calculi, thus increasing the risk of chronic catheter blockage and urinary tract infection. Whilst these solutions are used to reduce these risks, they also pose additional risks to people susceptible to AD. These cases highlight the need for judicious patient selection and clinical oversight and management of adverse events when using catheter rinse solutions in certain people living with SCI. This is supported by a decision-making algorithm and a response to AD algorithm.
This case report was prepared following the CARE Guidelines (supplementary file 1).
导言历史上,膀胱冲洗用于将治疗试剂直接灌入膀胱。这种做法已扩展到灌注解决导尿管问题(如结壳或形成生物膜)的溶液。这些产品似乎为长期使用导尿管的人提供了一种很有前景的策略。这些病例研究包括三名脊髓损伤 (SCI) 患者,他们在使用特定溶液冲洗导管时出现了严重的自主反射障碍 (AD)。讨论导尿管相关性尿路感染是 SCI 患者发病和死亡的一个重要原因。长期导尿管为机会性微生物提供了形成生物膜的载体,并创造了促进形成结石的环境,从而增加了慢性导尿管堵塞和尿路感染的风险。虽然使用这些溶液是为了降低这些风险,但它们也给易患 AD 的人带来了额外的风险。这些病例突出表明,在对某些 SCI 患者使用导尿管冲洗溶液时,需要明智地选择患者,并对不良事件进行临床监督和管理。本病例报告是根据 CARE 指南(补充文件 1)编写的。
{"title":"A case report of three people experiencing intractable autonomic dysreflexia following instillation of Uro-Tainer® Polyhexanide 0.02%","authors":"Louise C. Kelly, Joanne V. Glinsky, Lisa A. Harvey","doi":"10.1038/s41394-024-00626-5","DOIUrl":"https://doi.org/10.1038/s41394-024-00626-5","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>Historically, bladder washouts were used to instil therapeutic reagents directly into the bladder. This practice has expanded to include instillation of solutions that deal with catheter issues such as encrustation or formation of bio-film. They appear to provide a promising strategy for people with long term catheters. These products are readily available to purchase, but there is concern that people are using these solutions without a complete understanding of the purpose for the rinse and without clinical guidance to monitor response to treatment.</p><h3 data-test=\"abstract-sub-heading\">Case presentation</h3><p>These case studies include three people living with spinal cord injury (SCI) who developed severe autonomic dysreflexia (AD) when a catheter rinse was carried out using a particular solution. Each of the cases developed immediate and, in some cases, intractable AD requiring further intervention to resolve symptoms.</p><h3 data-test=\"abstract-sub-heading\">Discussion</h3><p>Catheter-associated urinary tract infection is a significant cause of morbidity and mortality in people living with SCI. Long-term catheters provide a vector for opportunistic micro-organisms to form bio-film and create an environment that promotes formation of struvite calculi, thus increasing the risk of chronic catheter blockage and urinary tract infection. Whilst these solutions are used to reduce these risks, they also pose additional risks to people susceptible to AD. These cases highlight the need for judicious patient selection and clinical oversight and management of adverse events when using catheter rinse solutions in certain people living with SCI. This is supported by a decision-making algorithm and a response to AD algorithm.</p><p>This case report was prepared following the CARE Guidelines (supplementary file 1).</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140602111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-03DOI: 10.1038/s41394-024-00632-7
Muhamad Faizal Zainudin, Salmah Anim Abu Hassan, Nyein Yin Khin
Introduction
NeuroAiD (MLC601 & MLC901)’s neuroprotective capabilities include limiting exaggerated calcium influx, decreasing excitotoxicity, reducing oxidative stress, and preventing glutamate-induced cell death. It has also been shown to facilitate synaptogenesis, neurogenesis, and neuroplasticity. However, its clinical efficacy has primarily been studied in the context of brain injuries, particularly stroke. NeuroAiD’s potential application in SCI remains largely untapped.
Case presentation
A 34-year-old male presented with C4 complete tetraplegia. Following surgical decompression and initial inpatient rehabilitation, he started consuming MLC901 two capsules three times daily at month 4 post injury for 6 months. He regained considerable neurological recovery following the supplementation. Apart from the improvement in the neurological level of injury, the patient exhibited motor recovery beyond the initial zone of partial preservation up to 24 months post injury.
Discussion
Our findings align with a recent animal study demonstrating MLC901’s potential to downregulate Vascular Endothelial Growth Factor (VEGF), a molecule known to increase vascular permeability and exacerbate tissue edema and infarction. In another animal study involving stroke-affected mice, MLC901 demonstrates the ability to promote neurological recovery by regulating the expression of proteins mediating angiogenesis, such as hypoxic inducible factor 1α, erythropoietin, angiopoietins 1 and 2, as well as VEGF. The anecdotal findings from this case report offer preliminary insights into NeuroAiD’s potential in facilitating recovery during post-acute and chronic phases of severe SCI, necessitating further exploration.
{"title":"Facilitation of neurological recovery in a complete spinal cord injury with NeuroAiD: case report","authors":"Muhamad Faizal Zainudin, Salmah Anim Abu Hassan, Nyein Yin Khin","doi":"10.1038/s41394-024-00632-7","DOIUrl":"https://doi.org/10.1038/s41394-024-00632-7","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>NeuroAiD (MLC601 & MLC901)’s neuroprotective capabilities include limiting exaggerated calcium influx, decreasing excitotoxicity, reducing oxidative stress, and preventing glutamate-induced cell death. It has also been shown to facilitate synaptogenesis, neurogenesis, and neuroplasticity. However, its clinical efficacy has primarily been studied in the context of brain injuries, particularly stroke. NeuroAiD’s potential application in SCI remains largely untapped.</p><h3 data-test=\"abstract-sub-heading\">Case presentation</h3><p>A 34-year-old male presented with C4 complete tetraplegia. Following surgical decompression and initial inpatient rehabilitation, he started consuming MLC901 two capsules three times daily at month 4 post injury for 6 months. He regained considerable neurological recovery following the supplementation. Apart from the improvement in the neurological level of injury, the patient exhibited motor recovery beyond the initial zone of partial preservation up to 24 months post injury.</p><h3 data-test=\"abstract-sub-heading\">Discussion</h3><p>Our findings align with a recent animal study demonstrating MLC901’s potential to downregulate Vascular Endothelial Growth Factor (VEGF), a molecule known to increase vascular permeability and exacerbate tissue edema and infarction. In another animal study involving stroke-affected mice, MLC901 demonstrates the ability to promote neurological recovery by regulating the expression of proteins mediating angiogenesis, such as hypoxic inducible factor 1α, erythropoietin, angiopoietins 1 and 2, as well as VEGF. The anecdotal findings from this case report offer preliminary insights into NeuroAiD’s potential in facilitating recovery during post-acute and chronic phases of severe SCI, necessitating further exploration.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140601664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-21DOI: 10.1038/s41394-024-00619-4
Nicole Cesca, Chantal Lin, Zeina Abu-Jurji, Aaron Wexler, Jonas Mark, Shane McCullum, Rija Kamran, Brian Chan, Kristin E Musselman
Study design: Qualitative exploratory OBJECTIVES: Rehabilitation following spinal cord injury (SCI) is a life-long process involving healthcare in a variety of settings, including facilities lacking SCI-specific services (i.e., non-SCI-specialized centers). Activity-based therapy (ABT) is a neurorestorative approach involving intensive, task-specific movement practice below the injury level. This study explored the existing knowledge, perceptions, and implementation of ABT among physical and occupational therapists working in non-SCI-specialized centers.
Setting: Canadian hospitals and community clinics DESIGN/METHODS: Semi-structured interviews were conducted with Canadian therapists who worked at non-SCI-specialized centers and treated at least one patient with SCI within the last 18 months. The Theoretical Domains Framework was used to develop interview questions that queried therapists' experiences in delivering SCI rehabilitation, their understanding of ABT and experience with its implementation. Interviews were audio-recorded, transcribed verbatim and analyzed using interpretive description.
Results: Four physical therapists and three occupational therapists, from diverse settings (i.e., acute care, inpatient rehabilitation, long-term care, outpatient rehabilitation, rural outpatient clinic) participated. Three themes were identified: (1) Available knowledge, resources and therapy time in non-SCI-specialized centers challenge ABT implementation, (2) How current therapy practices in non-SCI-specialized centers align with ABT and (3) Desire for ABT knowledge. Although participants were not familiar with the term ABT, it was identified that they were unknowingly incorporating some components of ABT into their practice. Participants expressed a keenness to learn more about ABT.
Conclusion: Current knowledge and implementation of ABT in non-SCI-specialized centers is limited. Tailoring ABT education to therapists at non-SCI-specialized centers may increase ABT implementation.
{"title":"Exploring knowledge and implementation gaps of activity-based therapy in centers lacking specialized spinal cord injury services: understanding therapists' perspectives.","authors":"Nicole Cesca, Chantal Lin, Zeina Abu-Jurji, Aaron Wexler, Jonas Mark, Shane McCullum, Rija Kamran, Brian Chan, Kristin E Musselman","doi":"10.1038/s41394-024-00619-4","DOIUrl":"10.1038/s41394-024-00619-4","url":null,"abstract":"<p><strong>Study design: </strong>Qualitative exploratory OBJECTIVES: Rehabilitation following spinal cord injury (SCI) is a life-long process involving healthcare in a variety of settings, including facilities lacking SCI-specific services (i.e., non-SCI-specialized centers). Activity-based therapy (ABT) is a neurorestorative approach involving intensive, task-specific movement practice below the injury level. This study explored the existing knowledge, perceptions, and implementation of ABT among physical and occupational therapists working in non-SCI-specialized centers.</p><p><strong>Setting: </strong>Canadian hospitals and community clinics DESIGN/METHODS: Semi-structured interviews were conducted with Canadian therapists who worked at non-SCI-specialized centers and treated at least one patient with SCI within the last 18 months. The Theoretical Domains Framework was used to develop interview questions that queried therapists' experiences in delivering SCI rehabilitation, their understanding of ABT and experience with its implementation. Interviews were audio-recorded, transcribed verbatim and analyzed using interpretive description.</p><p><strong>Results: </strong>Four physical therapists and three occupational therapists, from diverse settings (i.e., acute care, inpatient rehabilitation, long-term care, outpatient rehabilitation, rural outpatient clinic) participated. Three themes were identified: (1) Available knowledge, resources and therapy time in non-SCI-specialized centers challenge ABT implementation, (2) How current therapy practices in non-SCI-specialized centers align with ABT and (3) Desire for ABT knowledge. Although participants were not familiar with the term ABT, it was identified that they were unknowingly incorporating some components of ABT into their practice. Participants expressed a keenness to learn more about ABT.</p><p><strong>Conclusion: </strong>Current knowledge and implementation of ABT in non-SCI-specialized centers is limited. Tailoring ABT education to therapists at non-SCI-specialized centers may increase ABT implementation.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10957876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140185633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-21DOI: 10.1038/s41394-024-00628-3
Vanesa Bochkezanian, Kelsey J Henricksen, Benjamin J Lineburg, Louis A Myers-Macdonnell, Dennis Bourbeau, Kim D Anderson
Study design: Anonymous online survey OBJECTIVES: To investigate the priorities, needs and willingness to adopt nerve stimulation devices for managing neurogenic bladder and bowel function in people with spinal cord injury (SCI) living in Australia.
Setting: Online survey of people living with SCI in Australia.
Methods: This anonymous online survey used Qualtrics and was advertised via standard communication channels, such as advocacy groups representing the SCI community in Australia, social media, attending SCI sporting events and by word-of-mouth.
Results: Responses from 62 individuals (32% female, 68% male) were included. Bladder emptying through urethra without catheter was the highest priority for bladder function. Reducing time required for bowel routines and constipation were the top priorities regarding bowel function. The highest concern for internal/implanted devices was the 4% chance of device surgical removal, while wearing wires under the clothes was the main concern for external devices. 53% of respondents were willing to trial an implanted nerve stimulation device, while 70% would trial an external device to improve and gain independence in bladder and bowel function.
Conclusion: The findings of this study highlighted the potential role in which nerve stimulation can have in addressing bladder and bowel dysfunction in people with SCI, and have also identified that there was a need for Australian physiotherapists to evaluate their role in bladder and bowel dysfunction. Results from this study can help guide further research in nerve stimulation devices for bladder and bowel dysfunction in people with SCI.
{"title":"Priorities, needs and willingness of use of nerve stimulation devices for bladder and bowel function in people with spinal cord injury (SCI): an Australian survey.","authors":"Vanesa Bochkezanian, Kelsey J Henricksen, Benjamin J Lineburg, Louis A Myers-Macdonnell, Dennis Bourbeau, Kim D Anderson","doi":"10.1038/s41394-024-00628-3","DOIUrl":"10.1038/s41394-024-00628-3","url":null,"abstract":"<p><strong>Study design: </strong>Anonymous online survey OBJECTIVES: To investigate the priorities, needs and willingness to adopt nerve stimulation devices for managing neurogenic bladder and bowel function in people with spinal cord injury (SCI) living in Australia.</p><p><strong>Setting: </strong>Online survey of people living with SCI in Australia.</p><p><strong>Methods: </strong>This anonymous online survey used Qualtrics and was advertised via standard communication channels, such as advocacy groups representing the SCI community in Australia, social media, attending SCI sporting events and by word-of-mouth.</p><p><strong>Results: </strong>Responses from 62 individuals (32% female, 68% male) were included. Bladder emptying through urethra without catheter was the highest priority for bladder function. Reducing time required for bowel routines and constipation were the top priorities regarding bowel function. The highest concern for internal/implanted devices was the 4% chance of device surgical removal, while wearing wires under the clothes was the main concern for external devices. 53% of respondents were willing to trial an implanted nerve stimulation device, while 70% would trial an external device to improve and gain independence in bladder and bowel function.</p><p><strong>Conclusion: </strong>The findings of this study highlighted the potential role in which nerve stimulation can have in addressing bladder and bowel dysfunction in people with SCI, and have also identified that there was a need for Australian physiotherapists to evaluate their role in bladder and bowel dysfunction. Results from this study can help guide further research in nerve stimulation devices for bladder and bowel dysfunction in people with SCI.</p><p><strong>Sponsorship: </strong>n/a.</p>","PeriodicalId":22079,"journal":{"name":"Spinal Cord Series and Cases","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10957911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140185634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}