Journal of Spinal Cord Medicine最新文献

Study design: Retrospective study.

Objectives: To identify risk factors for renal scarring in individuals with spinal cord injury (SCI).

Setting: University-affiliated rehabilitation hospital in Yangsan, Republic of Korea.

Methods: We conducted a retrospective study involving 89 individuals with SCI. Only individuals with an SCI onset of at least six months prior were included to ensure recovery from initial detrusor atonicity. The participants were divided into two groups based on the presence of renal scars, as determined by 99mTc-dimercaptosuccinic acid scan. Demographic and urological data were collected, including the number of symptomatic urinary tract infections (UTIs) during the study period (2019-2023), bladder emptying methods, laboratory renal function tests, results from voiding cystourethrography, and urodynamic study metrics. We adjusted for suspected risk factors using multiple regression analysis.

Results: In individuals with SCI, the frequency of symptomatic UTIs (P < 0.001) and female sex (P = 0.02) were significantly associated with the presence of renal scars compared to those without scars. Following adjustment using multiple logistic regression analysis, the history of symptomatic UTIs emerged as the strongest risk factor for renal scarring, with an odds ratio of 3.9 (95% confidence interval: 1.27-11.97, P = 0.021). Using a model based on that predictor, the analysis revealed a predictive capacity with an AUC of 0.711.

Conclusion: Our study is the first to identify risk factors for renal scarring by analyzing demographic and urological parameters in individuals with SCI, with symptomatic UTI frequency emerging as the strongest risk factor. Our findings suggest that there may be unique, yet undetermined, pathophysiological mechanisms underlying renal scarring in the SCI population.

Objective: Cardiovascular disease (CVD) is the leading cause of mortality in individuals with spinal cord injury (SCI). This study examined patient characteristics, SCI-specific factors, and biochemical parameters associated with CVD risk.

Methods: A retrospective secondary analysis was conducted on 421 patients admitted between January and December 2017. Demographic, clinical, and biochemical data were recorded within 7 days of admission. CVD risk was estimated using the QRISK-2 score. Between-group differences were examined using Chi-square and Kruskal - Wallis tests. Logistic regression with multiple imputation was performed to identify predictors of CVD risk.

Results: Most patients were male (73%), aged <65 years (74%), and had traumatic SCI (68%). Over half (56%) were at medium/high CVD risk. Common biochemical abnormalities included vitamin D deficiency/insufficiency (56%), hypoalbuminemia (46%), anemia (42%), elevated C-reactive protein (CRP) (48%), low creatinine (55%), overweight/obesity (49%), high cholesterol (40%), low high-density lipoprotein cholesterol (43%), and high cholesterol/HDL ratio (28%). Univariate regression identified higher creatinine (OR 1.02), CRP (OR 1.01), and hypoalbuminemia (OR 0.923) as independent predictors of increased CVD risk, alongside traditional factors (male sex, older age, high total cholesterol, low HDL, elevated cholesterol/HDL ratio). Multivariate analysis confirmed significant associations of serum albumin (negative) and creatinine (positive) with CVD risk. No significant associations were found with injury level, onset, or nutritional risk scores.

Conclusion: Patients with SCI often present at admission with high rates of CVD risk and biochemical abnormalities. A more systematic approach with clear clinical guidance for routine CVD risk assessment at admission is required, alongside tailored early interventions.

Objective: To evaluate the efficacy and safety of botulinum toxin type A (BTA) in the treatment of people with Human T-lymphotropic virus 1-associated myelopathy/tropical spastic paraparesis (HAM/TSP).

Methods: A randomized, double-blind, placebo-controlled clinical trial, composed of individuals over 18 years old, with HAM/TSP, who had not used BTA to treat spasticity. The primary outcomes were spasticity (Modified Ashworth Scale) and safety (adverse events), and the secondary outcomes were pain (Visual Analogue Scale and Michigan Body Map), functional independence (Functional Independence Measure), functioning level (World Health Organization Disability Assessment Schedule), and quality of life (Short Form Health Survey), assessed right before and 3 months after the intervention. Participants were randomized into two groups: BTA and placebo control (saline).

Results: 40 participants (20 in each group) were analyzed. The assessor, neurologists, and participants were blind to group allocation. The average BTA dose per participant was 317U (± 189U) for the hip adductors, hamstrings, triceps surae, and tibialis posterior. There was a small significant difference between groups in favor of the BTA group in general health status (d = 0,33; p = 0,040) related to quality of life. There were no significant differences in spasticity, risk of adverse effects (RR = 1,09; p = 0,749), and in the other outcomes.

Conclusion: BTA is safe for people with HAM/TSP. However, the first dose of BTA was unable to improve spasticity, pain, functioning level, and quality of life in people with HAM/TSP 3 months after injection. New application strategies of BTA need to be investigated in people with HAM/TSP.

Objective: To evaluate hospital outcomes of surgical corrections of spinal deformity in children with spinal cord injury (SCI).

Study design: : Cross-sectional study.

Setting: National Inpatient Sample (1998-2021) was used to identify in-hospital outcomes of spinal fusion for spinal deformity.

Participants: : 768 children (0-17) with SCI.

Interventions: : Not applicable.

Outcomes measures: Critical care intervention (CCI) complications, hospital length of stay, charges, and discharge disposition. Individual and hospital characteristics were noted.

Results: Average age 14 (SD = 6), 48% females, 65% non-Hispanic White. Most cases were incomplete-SCI (38% thoracic, 31% cervical). Most surgeries occurred in large (66%) and urban teaching (93%) hospitals. A quarter received CCI and 43% developed complications. Median length of stay was 8 days (interquartile range: 5-14) and median charges were $230,136 (interquartile range: $150,131-$356,481). Mortality was low (<2%) and 41% were discharged to home healthcare or a medical facility. Having three or more comorbidities was associated with worse outcomes. Children on Medicaid were more likely to receive CCI. Older age, comorbidities, income, injury completeness, and bone fracture increased the likelihood of discharge to more care.

Conclusion: Spinal fusion for spinal deformity in children with SCI results in significant morbidity, prolonged hospital stays, substantial charges, and frequent post-discharge care. These findings underscore the significant healthcare burden and morbidity associated with spinal fusion for spinal deformity in children with SCI, emphasizing the need for optimized perioperative management and long-term follow-up. Future research should evaluate longitudinal outcomes. Altogether, it would guide restorative programs aiming to prevent or slow deformity progression.

Objectives: To analyze mortality, causes of death and survival in patients with traumatic spinal cord injury (TSCI) in Galicia after discharge; compare global mortality and cause-specific mortality against the Galician population; and describe risk factors for mortality.

Study design: A retrospective cohort study.

Setting: A spinal cord injury Unit from a tertiary referral hospital.

Methods: A cohort of TSCI patients discharged between January 2011 and December 2021. Causes of death (ICD-10) and survival time were obtained from the electronic health record. Global mortality and cause-specific mortality were compared with the Galician population using standardized mortality ratios (SMR). Survival was analyzed using the Kaplan-Meier method. Risk factors were studied using a Cox proportional hazards regression model.

Results: A total of 438 patients were included (74.89% men), of whom 122 died by 30 June 2024. Mean survival time was 122 months. Survival was decreased in older patients, those with complete cervical injuries and women. TSCI patients had an increased mortality (SMR 2.2) compared with the Galician population. The most common causes of death were respiratory diseases. Cause-specific SMRs were significantly increased for respiratory diseases (SMR 10.22), urinary tract diseases (SMR 16.92) and pressure ulcers (SMR 37.74). Risk factors for mortality were mechanical ventilation or tracheostomy at discharge, having an indwelling catheter at discharge, and destination place at discharge different from the patient´s previous home.

Conclusions: TSCI patients in Galicia, especially women and older patients, have an increased mortality. Respiratory diseases are the most common cause of death. Special attention should be paid to respiratory management and destination after discharge.

Context: Upper limb (UL) splinting interventions are commonly delivered to people following spinal cord injury (SCI) as part of multi-modal rehabilitation; however, their clinical efficacy remains unclear and a wide variety of splinting interventions are used in clinical practice and described in the literature.

Objective: This study aimed to map out the available evidence and guidelines on the topic, to summarize the breadth of knowledge and identify knowledge gaps.

Methods: A scoping review was conducted using the Arksey & O'Malley's methodological framework. Seven electronic databases were searched for literature evaluating upper limb splinting interventions for SCI rehabilitation. Two independent reviewers screened results. Findings were synthesized narratively and reported according to the PRISMA-ScR checklist.

Results: 21 primary studies evaluating traditional (n = 13) and non-traditional (n = 3) splints, five qualitative studies and 15 clinical guidelines were included. Most studies evaluated hand and wrist-based splints, which were predominantly used to optimize hand function. Large variations in terms of purpose, type, dosage, outcome assessment and impact of splinting interventions were identified. All clinical guidelines lacked detail and acknowledged the need for tailoring.

Conclusion: Considerable heterogeneity amongst the UL splinting literature and guidelines for SCI rehabilitation exists, with sub-optimal reporting of recommendation for the interventions. Studies were limited by weak methodological designs and small samples sizes, highlighting the need for high-quality mixed-methods trials that have been co-designed by patient and clinical stakeholders. There is a need to develop more robust clinical guidelines specifically for SCI rehabilitation.

Context: Clean intermittent self-catheterization (CISC) is a first-line bladder management strategy for patients with spinal cord injury (SCI). However, complications such as urinary tract infections and stone formation are relatively common. The retention of the catheter as an intravesical foreign body is an exceedingly rare event and can present with symptoms similar to infection or radiolucent calculi.

Findings: A 36-year-old male with a history of chronic spinal cord injury (T12, AIS A) utilizing clean intermittent self-catheterization (CISC) presented with urinary frequency and the presence of "gravel-like debris". The patient was afebrile, and initial plain radiography yielded no significant findings. A computed tomography (CT) revealed a high-density tubular structure within the bladder. Cystoscopy successfully removed two urinary catheters, leading to symptom resolution. On gross inspection, neither showed any apparent tear or breakage. An attempt to use a handled catheter was not tolerated; however, after reinforced technique education, including the caregiver, the patient has remained symptom-free for over 12 months with no recurrence.

Conclusion/clinical relevance: In CISC users with persistent lower urinary tract symptoms despite empiric UTI management and negative first-line imaging, intravesical foreign bodies should be considered. Early non-contrast CT can clarify radiolucent or atypical etiologies and expedite definitive cystoscopic treatment. Prevention should pair ergonomic catheter selection (e.g. flared or handled designs as tolerated) with structured skills refreshers during routine SCI follow-up; caregiver participation can be included when appropriate.

Background: Bone loss following spinal cord injury (SCI) leads to an increased risk of fragility fractures, especially at the knee and hip. While research to date has primarily focused on mitigating bone loss in the acute phase, our recent publication demonstrated an improvement in bone mineral and strength at the lumbar spine and hip, but not the knee, in women with chronic SCI and osteoporosis after 12 months of romosozumab therapy. This paper presents 12 months of follow-up treatment with oral alendronate, which aimed to determine whether prior gains could be maintained with transition of therapy in the same sample.

Methods: Ten study participants completed the alendronate treatment. Dual-energy X-ray absorptiometry (DXA) and computed tomography (CT) scans were taken at the end of the treatment year to quantify changes to bone mineral density (BMD) and CT-based finite element (FE) estimations of fracture strength. Second year results were compared to the first year of romosozumab treatment data using non-parametric analyses.

Results: No significant changes between the month-12 and month-24 visits were observed for BMD at the lumbar spine (P = .432) or total hip (P = .432). Correspondingly, no significant change in FE-derived strength at the proximal femur (P = .695) was observed. There were no appreciable changes in BMD or bone strength at the knee following the alendronate intervention.

Conclusions: Overall, one year of treatment with monthly romosozumab followed by one year of treatment with weekly alendronate, significantly increased and maintained bone mineral at the hip, but not the knee, in women with chronic SCI and secondary osteoporosis.