Journal of Spinal Cord Medicine最新文献

Context: The Falls-Efficacy Scale-International (FES-I) was developed to assess concern for falling in older adults. This measure has since been used with people with motor incomplete spinal cord injuries (iSCI) in research and clinical practice, but the psychometric properties have not yet been determined in this population.

Objective: The objectives of this research study were to determine (1) the test-retest reliability of the FES-I in people with chronic iSCI, and (2) the validity (i.e. convergent and known-groups) of the FES-I in people with chronic and subacute iSCI.

Methods: Secondary data from three studies were used; two studies included participants with chronic iSCI (n = 20; n = 25), and one study included participants with subacute iSCI (n = 40). Data from one study that included participants with chronic iSCI were used to determine the test-retest reliability of the measure. Data from all studies were used to determine the convergent validity of FES-I scores with the Activities-specific Balance Confidence (ABC) Scale and known-group validity for both chronic and subacute populations.

Results: FES-I scores were found to be reliable in people with chronic iSCI (ICC = 0.91) and showed moderately strong correlations with ABC scale scores in both chronic (r = -0.71, P < 0.001) and subacute (r = -0.88, P < 0.001) participants. Known-group validity was only found for FES-I scores and people with a self-reported fear of falling in the subacute population.

Conclusions: The FES-I is a reliable and valid measure for use in iSCI research and clinical practice; further research is needed to determine predictive and descriptive validity.

Context/objective: Heterotopic ossification (HO), the abnormal formation of bone in soft tissue, is a known complication of spinal cord injury (SCI). Prior studies have identified several associated factors but are limited by small sample sizes and provide little insight into the burden on the healthcare system. This study will assesses national trends in hospitalizations for SCI-induced HO in the U.S. from 2016 to 2021 and identifies demographic and clinical factors associated with HO in hospitalized SCI patients.

Design: Retrospective, population-based cross-sectional study.

Setting: Healthcare Cost and Utilization Project's National Inpatient Sample (NIS) from 2016 to 2021.

Participants: A total of 380,928 hospitalizations with SCI, with or without HO, were identified.

Outcome measures: Hospitalizations with a primary or secondary SCI diagnosis, with or without HO complication, were identified using ICD-10 codes. Survey-weighted logistic regression models assessed associations between SCI-induced HO and demographic and clinical factors. Interaction analyses evaluated potential effect modification.

Results: Of 380,928 SCI hospitalizations, 181 (0.048%) included an HO diagnosis. Younger age, male sex, hip-pelvic trauma, pressure ulcers, spasticity, thoracic trauma, and thromboembolism were associated with increased odds of HO; lung injury and pneumonia/pneumonitis were associated with decreased odds. Thoracic and complete SCI were independently associated with HO, and a significant interaction was observed between SCI level and completeness (P<0.0001).

Conclusion: Hospitalized SCI patients with these risk factors should be closely monitored for HO prevention, early detection, and treatment. The inverse association between HO and lung injury or pneumonia warrants further investigation.

Background: Infiltrations of the spine can be used to treat nociceptive or neuropathic pain. There is little data in the literature on the use of spinal injections in patients with paraplegia.

Objective: The aim of this study is to determine whether patients with spinal cord injury experienced improvement in pain and spasticity following spinal injection.

Methods: 19 (9 female, 10 male) patients (5 patients AIS A, 5 patients AIS C, 9 patients AIS D), including 9 tetraplegic and 10 paraplegic patients, with 22 injection techniques and a follow-up of 4.2 months (1-12 months) were retrospectively examined in our spinal cord injury Center in 2022 and 2023. The pain intensity on the NRS (Numerical Rating Scale), the MAS (Modified Ashworth Scale) for the graduation of muscle tone and the Spinal Cord Independence Measurement (SCIM) were assessed before infiltration and as part of the follow-up examination.

Results: Image intensifier-assisted facet and sacroiliac joint infiltrations were performed in 12 patients, CT-guided nerve root infiltrations and epidural injections in 10 patients with corresponding symptoms and image morphological correlate without complications. In all patients, a statistically significant reduction in pain on the NRS could be achieved (4.05 ± 1.84; p < 0.0001). A trend towards improvement was documented in the analysis of the MAS (0.14 ± 0.35; p = 0.08), whereas a significant improvement was statistically detected in the analysis of the SCIM (-15.59 ± 18.23; p = 0.0006).

Conclusion: Our study represents the first retrospective exploratory analysis (phase I-style feasibility study) after spinal injection in patients with spinal cord injury. The primary results in terms of pain intensity, muscle tone and independence are promising and, in our view, represent a further therapeutic approach in addition to pharmacological and non-pharmacological therapy options. However, further investigations are necessary for this.

Background: spinal cord injury (SCI) is a pathological condition in which the structure and function of the spinal cord are damaged due to trauma or disease. Patients with SCI often suffer from neuropathic pain. Virtual reality (VR) is a promising intervention for pain management. However, the effect of VR in managing neuropathic pain in patients with SCI remains unclear.

Purpose: The purpose of this study was to evaluate the effect of VR on neuropathic pain in patients with SCI.

Methods: This study adhered to PRISMA guidelines and was registered on PROSPERO. PubMed, Embase and Web of Science databases were searched for studies involving VR, pain, and anxiety in patients with SCI published up to February 2025. We assessed the risk of bias using the Cochrane ROB tool and the ROBINS-I tool. A meta-analysis of the included data was conducted using RevMan 5.4 software.

Result: A total of seven studies were included, including four pre-post studies and three RCTs. Overall, VR intervention significantly reduced neuropathic pain in SCI patients (MD = -2.26, 95% CI: -2.89 to -1.63, P < 0.001). VR was more effective than non-VR conditions (SMD = -0.99, 95% CI [-1.51, -0.48]).

Conclusion: VR demonstrated efficacy in relieving neuropathic pain among SCI patients. Furthermore, VR provided superior pain relief compared to non-VR conditions. However, additional high-quality research is warranted to explore further the comparative effectiveness of VR interventions relative to other treatments and to identify the optimal intervention parameters and protocols.

Context: A 68-year-old woman with C1 AIS A spinal cord injury.

Findings: This patient demonstrated preserved diaphragmatic function due to a motor Zone of Partial Preservation (ZPP) extending to C7. Diaphragm ultrasound confirmed intact excursion, supporting partial ventilator weaning.

Conclusion: This case underscores the clinical value of ZPP documentation in high cervical SCI management.

Background context: Posttraumatic syringomyelia (PTS) is a rare complication arising from spinal cord injury (SCI), characterized by the emergence of a cavity filled with fluid within the spinal cord parenchyma. The management of PTS remains a subject of debate.

Purpose: This study aimed to examine initial symptoms, surgical treatments, and surgical outcomes of PTS.Study Design/Setting: Systematic review.

Methods: Keywords were chosen according to MeSH and Emtree terms in the Medline and Embase databases, respectively, and systematically searched in the Medline and Embase databases until March 2023. Mechanism of injury, level of injury, past treatment history, procedure, surgical complications, follow-up time, sensory, motor, pain and other assessments before and after surgery as well as the overall outcome of the surgery were extracted. We stratified the findings into three sections: (a) findings from provided summary statistics in longitudinal and before-after studies, (b) findings from studies that provided detailed characteristics of patients, and (c) findings from case reports.

Results: After evaluation of 3232 unique records, 68 articles were included in this systematic review. Data of 1175 patients were included from 37 longitudinal and before-after studies and 31 case-reports. The level of injury is predominantly thoracolumbar, and cyst sizes are generally larger than 1 centimeter. Our study found that surgical treatment of PTS leads to an overall improvement in signs and symptoms (range: 58.02-93.5%) particularly in sensory symptoms (range: 24.77-44.1%), motor function (range: 41.83-54.35%), pain (range: 54.2-56.31%) and spasticity symptoms (up to 54.4%) in the patients. These results, retrieved from before-after and longitudinal studies, were also confirmed by case-reports.

Conclusion: Surgical interventions, ranging from cyst removal to shunting procedures, showed overall effectiveness, with the majority of patients experiencing improved neurological symptoms, particularly in pain, motor weakness, and spasticity.

Context: Autonomic dysreflexia (AD) is a life-threatening condition among individuals with spinal cord injury (SCI) that has garnered increased attention, given the dangerous immediate and long-term sequelae if left untreated. In 2014, a clinical review was published to highlight cases of AD associated with life-threatening outcomes and mortality.

Objective: The objective of our study was to provide an update on life-threatening sequelae and cases of mortality secondary to AD described in the literature.

Methods: A review was done through an online search to identify cases in the literature describing life-threatening sequelae of AD and mortality. A search was conducted on databases including Embase, PubMed, and Scopus to identify relevant articles published between 2013 and 2024. Our search yielded fifteen eligible articles describing eighteen cases of life-threatening AD.

Results: Two (11%) cases resulted in mortality. Fifteen (83%) cases resulted in CNS complications and three cases (17%) resulted in cardiovascular complications of AD. Bowel and bladder triggers were responsible for most cases of AD (89%), including the two mortality casesy. One of the cases, which resulted in mortality, was asymptomatic.

Conclusions: Relatively few cases of life-threatening sequelae of AD have been reported in the literature over the last ten years. This could be related to increasing recognition of AD, timely management, and improved outcomes. Monitoring cardiovascular health remains a critical component of longitudinal care for individuals with SCI to prevent cardiovascular and neurological sequelae.

Context: Brown-Séquard syndrome is a rare condition caused by injury to one side of the spinal cord. It mostly results from trauma. Ischemic lesions usually do not cause this syndrome because the spinal cord is involved bilaterally.

Findings: We reported a case with paralysis of the right lower extremity and hypoesthesia of the left lower extremity after a coronary intervention. His neurological exam and radiological findings match those of Brown-Séquard syndrome.

Conclusion: Iatrogenic spinal cord ischemia after endovascular procedures are rarely seen. Unilateral spinal cord ischemia was demonstrated firstly with this case.

Objective: To investigate the association between plasma fibroblast growth factor 21 (FGF21) and conventional metabolic parameters in people with chronic spinal cord injury (SCI).

Design: A cross-sectional study.

Setting: An SCI-specialized rehabilitation facility in a university hospital.

Participants: Fifty-six participants with chronic SCI (duration of SCI ≥ 1 year).

Intervention: Not applicable.

Main outcome measure: After informed consent, demographic and SCI-related parameters were collected. Metabolic parameters, including anthropometric measures, body composition assessed by dual-energy x-ray absorptiometry, and blood tests, were evaluated. Plasma FGF21 levels were determined using an enzyme-linked immunosorbent assay (ELISA) method. Metabolic syndrome was diagnosed by the American Heart Association (AHA)/the National Cholesterol Education Program (NCEP) III Criteria. Associations between plasma FGF21 levels and other parameters were determined using multivariable linear regression analyses.

Results: Among 56 participants, 37 people (66%) were male. The mean (SD) age was 43.8 (10.6) years. Twelve people (21%) had tetraplegia and 14 people (15%) had complete SCI. Twelve (21%) participants were diagnosed with obesity, prediabetes, and metabolic syndrome (MetS). Using multivariable analysis adjusting for all demographic data, medical conditions, and metabolic parameters, being diagnosed with MetS had an independent positive association with plasma FGF21 level (P = 0.020, Beta coefficient = 0.776 [95%CI: 0.126-1.426]; multivariable linear regression analysis).

Conclusions: In people with chronic SCI, MetS is an independent positive associated factor of plasma FGF21 level, which may suggest the presence of FGF21-resistant condition. This result addresses the interesting role of FGF21 in the development of cardiometabolic diseases in people with chronic SCI.